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Speaker 1: It's the big take from Bloomberg News and I Heart Radio.

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Speaker 1: I'm West Cassova today. How COVID exposed the dangers of

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Speaker 1: heavily sedating patients in the hospital. In the early days

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Speaker 1: of the COVID pandemic. This is before vaccines, people with

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Speaker 1: severe cases who went to the intensive care unit were

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Speaker 1: often placed on ventilators to keep them alive. Doctors heavily

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Speaker 1: sedated many of these patients so they could stay calm

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Speaker 1: and rest, and that invasive treatment helped a lot of

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Speaker 1: COVID patients survive, but it came at a cost. Being

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Speaker 1: under it on heavy drugs for days or weeks has

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Speaker 1: now left many of them with lasting physical and mental

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Speaker 1: health impairments. I did not sleep well. I would get

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Speaker 1: panic attacks during the day, and I didn't attribute them

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Speaker 1: to PTSD or anything. I just figured I've been through

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Speaker 1: this and now it's just sort of trailing off into

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Speaker 1: the sunset. That's Kelly McCarthy. She spent weeks on a

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Speaker 1: ventilator as a result of COVID and lived, but she

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Speaker 1: now faces a very different life. We'll hear more of

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Speaker 1: her story a bit later. First, a conversation with Dr

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Speaker 1: Wes Ealie He's a pulmonologist and critical care physician at

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Speaker 1: Vanderbilt University Medical School, and he's seen up close the

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Speaker 1: effects of sedation on patients. He's also the author of

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Speaker 1: the book Every Deep Drawn Breath, A Critical Care Doctor

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Speaker 1: on Healing, Recovery, and Transforming Medicine in the i c U. Doctor.

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Speaker 1: In the early days of COVID, very sick patients were

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Speaker 1: going to the hospital and doctors were trying to figure

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Speaker 1: out what to do. There weren't a lot of answers,

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Speaker 1: and sometimes people were being very heavily sedated. You've spend

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Speaker 1: decades studying the effects of sedation. Can you explain the

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Speaker 1: difference between the proper use of sedation and when it's overused? Yes,

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Speaker 1: you know, when you come in the i c U

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Speaker 1: and you have to get life support like a ventilator.

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Speaker 1: It makes sense that as a doctor, I would want

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Speaker 1: to provide my patient with a level of comfort that

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Speaker 1: sometimes comes with unconsciousness, and so a sedative drug. But

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Speaker 1: what we've learned over thirty years of research west thousands

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Speaker 1: and thousands of patients and NIH and federally funded studies

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Speaker 1: is that we can really cause a lot of harm

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Speaker 1: to our patients. By giving them too much sedation for

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Speaker 1: too long. And so what we have done is randomized

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Speaker 1: trials over the years where we've proven that people can

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Speaker 1: actually be more likely to live on the back end

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Speaker 1: of critically illness if we shorten the sedation, give them

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Speaker 1: less and overall, don't burden them with drugs like benzo

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Speaker 1: days appines, which were really common during COVID. Unfortunately, you

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Speaker 1: worked as a critical care physician in those early days,

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Speaker 1: kind of scary. They weren't vaccines yet. What sort of

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Speaker 1: practices did you see that you've now learned weren't actually

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Speaker 1: best practices. I'm gonna tell you through the story of

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Speaker 1: a patient. I had a patient named Teresa Martin, and

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Speaker 1: I have permission to use her name. In nineteen ninety

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Speaker 1: I cared for her with a pattern of sedation which

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Speaker 1: was heavy and mobilizing and put her in a coma

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Speaker 1: for many days, And then for the next twenty five

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Speaker 1: years I did research to try and figure out, with

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Speaker 1: the rest of us around the world, how do we

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Speaker 1: keep people more awake, more learned, more in communication with

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Speaker 1: their family members, and earlier mobilized. And we had made

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Speaker 1: all this progress until twenty nineteen, we had more people living,

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Speaker 1: they were living with less disabilities, et cetera. And then

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Speaker 1: COVID hit West. I'm standing in the ICU in the

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Speaker 1: COVID I C you caring for a man named Fred

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Speaker 1: Reyes also have permission to use his name, and he

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Speaker 1: was on the ventilator, and I thought to myself, Oh

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Speaker 1: my gosh, this is deja boo. I'm back in Teresa Martin.

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Speaker 1: We have regressed thirty years in our practices, and that's

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Speaker 1: exactly what happened globally. We proved in a study of

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Speaker 1: two thousand one COVID I SEE patients that we were

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Speaker 1: over using benzos and under using family and this was

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Speaker 1: creating a massive amount of a cute brain dysfunction and

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Speaker 1: accelerating death during COVID. You said you were over using benzos,

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Speaker 1: these very powerful sedatives and under using families. What exactly

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Speaker 1: do you mean by that? The best way to keep

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Speaker 1: somebody's brain online or on track when they're critically ill

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Speaker 1: is to give them a little bit of sedation at

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Speaker 1: the beginning on the ventilator. We do need sedation at

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Speaker 1: the beginning when we first put somebody on the ventilator,

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Speaker 1: but it's on day two or day three or day

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Speaker 1: four where we need to be waking people up every

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Speaker 1: single day to allow them to look in the eyes

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Speaker 1: of their wife, their spouse, their husband, whatever it may be,

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Speaker 1: so they can remember, oh, I have a reason to live.

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Speaker 1: And they're getting by with a very scary how in

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Speaker 1: the I c U. They have lions and tubes and

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Speaker 1: they can't talk and they need to see their family

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Speaker 1: and they to be able to process that well. During

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Speaker 1: COVID we pummeled them with benzod a zapines. There was

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Speaker 1: a paper early on in the New England Journal of Medicine.

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Speaker 1: They showed that eight six percent of COVID patients were

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Speaker 1: getting benzoda zapines like at a van or medaisa LAMB.

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Speaker 1: And just prior of COVID we had pretty much gotten

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Speaker 1: rid of those drugs altogether. They caused a tremendous amount

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Speaker 1: of delirium and harm and so we don't like to

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Speaker 1: use those on people. And so why were they used

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Speaker 1: so frequently in COVID. Why did they bring these drugs back?

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Speaker 1: What was it about COVID care that sort of threw

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Speaker 1: the rule book out the window. Just prior of COVID,

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Speaker 1: we had a safety checklist in the I c U.

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Speaker 1: It's called the A D C, D E F bundle.

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Speaker 1: We called the A T F bundle. That essentially was

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Speaker 1: waite people up, get them out of bed, and have

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Speaker 1: their family there. Well. At the beginning of COVID, when

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Speaker 1: I wasn't vaccinated and no one else was vaccinated, were

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Speaker 1: afraid to have family members come in, so we kept

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Speaker 1: family away. We kept the patient in the room, We

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Speaker 1: shut the door, and we had the patient behind the glass.

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Speaker 1: They had a tube down their throat, so to make

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Speaker 1: them not able to pull that tube out and take

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Speaker 1: themselves off of a ventilator, which we call self excavation,

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Speaker 1: we snowed them with benzos because they are the deepest

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Speaker 1: coma laden drug that we could give them, and also

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Speaker 1: the drug probofall those were the drugs that we were

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Speaker 1: using because we had to keep the person so deeply

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Speaker 1: in a coma, since we weren't free to go in

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Speaker 1: and out of the room as much as we wanted to.

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Speaker 1: When that happened, family members weren't allowed in. Doctors and

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Speaker 1: other members of the care team weren't able to check

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Speaker 1: as frequently. What did we learn about what the effects

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Speaker 1: were both for the treatment of COVID and after people recovered,

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Speaker 1: we were doing the best we could with the light

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Speaker 1: we had at the time. Now we know that vaccines

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Speaker 1: work and that personal protective equipment PPE works. It was

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Speaker 1: anti medicine. It was a time when we couldn't have

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Speaker 1: the families there. But what we learned were two main things.

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Speaker 1: When we put all those COVID patients deeply indetective coma

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Speaker 1: like we had been back in the ninety nineties, it

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Speaker 1: increased dementia. It increases a problem called post intensive care syndrome,

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Speaker 1: which is p I c S or the so called PICKS.

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Speaker 1: And on the back end of the ice use day,

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Speaker 1: if somebody survives, what they land with in their life

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Speaker 1: is big time cognitive impairment, memory impairment, the inability to

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Speaker 1: do their job. They also have way more in the

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Speaker 1: terms of muscle and nerve disease, and then more depression

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Speaker 1: and post traumatic stress disorder our PTSD. So we were exacerbating,

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Speaker 1: if you will, the likelihood of them getting post intensive

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Speaker 1: care syndrome and having all these disabilities in the months

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Speaker 1: and years after they tried to recover from their COVID.

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Speaker 1: So for decades you have studied this. You actually wrote

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Speaker 1: the rule book when it comes to how to properly

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Speaker 1: sedate patients with other physicians you work with. Knowing what

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Speaker 1: you know now from the experience treating and sedating COVID patients,

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Speaker 1: have you changed the rules are added to them in

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Speaker 1: a way using this experience to improve care in the future.

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Speaker 1: We absolutely have. What we have done is we have said, Okay,

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Speaker 1: we don't need to start from scratch. We have twenty

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Speaker 1: five years of randomized control trials and Cowork studies. We

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Speaker 1: don't have to start over. So what we've done is

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Speaker 1: we've worked nationally and internationally with intensive care societies and

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Speaker 1: we're taking the abc DF bundle, the hwo F bundle,

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Speaker 1: and we're re implementing it on a large scale all

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Speaker 1: over the world to say, the next time we have

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Speaker 1: a pandemic like this, we are going to make sure

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Speaker 1: that we do not abandon all of this data which

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Speaker 1: we know saves lives, produces length of stay, cuts down

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Speaker 1: cost of care, and helps people survive without an acquired dementia.

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Speaker 1: And so that's what we're doing to move forward both

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Speaker 1: currently in the Perry pandemic period of COVID, because there's

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Speaker 1: still hundreds of people in the i c US with

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Speaker 1: COVID right now, although the numbers are way down and

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Speaker 1: we're gonna have another pandemic, we just need to make

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Speaker 1: sure we do it more safely next time. So dr

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Speaker 1: we're talking about COVID in a possible future pandemic, but

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Speaker 1: just in normal life. If one of our listeners, a

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Speaker 1: member of their family falls ill and requires sedation and

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Speaker 1: they're in the hospital, what can people do to make

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Speaker 1: sure that the sedation they're getting does follow these rules

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Speaker 1: and that they're going down the right path instead of

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Speaker 1: a less fortunate one. First of all, if you are

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Speaker 1: with a loved one who is in the I c

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Speaker 1: U and on a ventilator, then you are their advocate.

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Speaker 1: And I want you to know that it is okay

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Speaker 1: to be their advocate and to request to be present

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Speaker 1: at the bedside. These days of limited visitation should be over,

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Speaker 1: and they are wrong, and you should challenge that and

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Speaker 1: say I need to be with my loved one because

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Speaker 1: they need an advocate and they need to make eye

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Speaker 1: contact with me so they can remember that they have

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Speaker 1: a why to live. We aunt heal people West with

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Speaker 1: just science. It's over. We know that we have to

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Speaker 1: have humanism and science We need physical touch and that

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Speaker 1: personal humanistic approach plus the science. That's how we completely

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Speaker 1: heal human being. So that loved one should say, I

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Speaker 1: want to be on rounds. Let me listen to what

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Speaker 1: you're doing and give me a lay explanation of what's happening.

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Speaker 1: I will tell you what my loved one needs. I

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Speaker 1: know what matters to them, and I call this West

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Speaker 1: flipping the preposition. It's not just about what's the matter

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Speaker 1: with someone, it's what matters to someone. So I have

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Speaker 1: to have the family members there with me to tell

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Speaker 1: me what Mr Smith, what's important to him, and how

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Speaker 1: far I should push different types of interventions, how aggressively

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Speaker 1: I should make that wakes up every day. Should we

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Speaker 1: try and get him hearing? His granddaughter today is she's

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Speaker 1: the most important person who's gonna help him? Have you

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Speaker 1: know the reason to live. We're gonna take this humanistic

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Speaker 1: approach and put it alongside the science, and we need

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Speaker 1: the family there to make that happen. Dr wessey Elie,

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Speaker 1: thanks so much for talking to me today. My brother

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Speaker 1: styke you travling after the break the widespread effects of

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Speaker 1: heavy sedation on patients. Bloomberg Senior Editor and Biosecurity correspondent

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Speaker 1: Jason Gale joins me now from Melbourne, Australia. You have

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Speaker 1: written this very interesting story about what's really a side

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Speaker 1: effect and very serious one of COVID treatment, especially in

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Speaker 1: the early days before the vaccine, when people were sedated

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Speaker 1: and often sedated to keep them on ventilators. You writing

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Speaker 1: your story about a woman named Kelly McCarthy. Can you

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Speaker 1: tell us about her? Kelly McCarthey is a woman now

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Speaker 1: fifty two years old. She's a grandmother. She was previously

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Speaker 1: working full time as an insurance claims adjusted just outside

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Speaker 1: of Boston. She got sick with COVID in early one

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Speaker 1: was actually around the peak of the pandemic, the pandemics

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Speaker 1: first went away in the US. I remember I was

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Speaker 1: feeling very crummy, you know, just like a regular bug

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Speaker 1: or something, and so I went and I got soup

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Speaker 1: and whatever's just I was going to nurse it on

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Speaker 1: But the they just said, we can't keep doing this

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Speaker 1: We think of people when they're sedated as being asleep,

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Speaker 1: but what you describe that Kelly McCarthy and other patients

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Speaker 1: essentially studied hallucinating. All kinds are different, sometimes horrific things.

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Speaker 1: was working its way into into my dreams. Like I

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Speaker 1: I just intibated you whatever. And I looked at her

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Speaker 1: and she she said, um, okay, so I'm going to

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Speaker 1: kill you in my drink. I've doubt she said that

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Speaker 1: in I See You. One of the other ironies of

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Speaker 1: survival rate than we've seen in previous pandemics, certainly influenza pandemic,

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Speaker 1: and so the very thing that kept them alive is

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Speaker 1: something that has pointed up big problems with people being

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Speaker 1: heavily sedated. Yeah. Absolutely, we are now dealing with the

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Speaker 1: of a million patients in the US, who survived their

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Speaker 1: have some degree of impairment following that. I don't drive

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Speaker 1: at this point because if my legs are kicking out

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Speaker 1: forget things, and so that's difficult because literally I'll be like, oh,

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Speaker 1: I got to look that up on Google, pick up

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Speaker 1: that's that's fun. So but only if my hands get

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Speaker 1: to like that. They gave me surgery. I had carpal

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Speaker 1: So the impairments really go from the head to the toes.

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Speaker 1: It's all kinds of things. There's mental cognitive impairments to do. Obviously,

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Speaker 1: dental issues. Often um patients it's hard to clean their teeth,

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Speaker 1: for example, patients can get bed sores. They essentially get

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Speaker 1: what's called post intensive care syndrome, and that is this

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Speaker 1: sort of umbrella term for really a large raft of

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Speaker 1: problems that can be quite enduring. My conversation with Jason

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Speaker 1: Gale continues after the break. Jason, you write in your

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Speaker 1: story that even though Kelly is grateful to be alive,

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Speaker 1: It really is. Her daughter Rachel mentioned that she was

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Speaker 1: previously working multiple jobs, working sometimes seven ninety hours per week.

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Speaker 1: She's now unable to work at all, and the outlook

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Speaker 1: to retire so young. It's just the isolation. It's not

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Speaker 1: even the financial you know, because we do all right,

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Speaker 1: so that's fine. But it's like I would go to

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Speaker 1: and chit chat and talk to people and do my

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Speaker 1: work or whatever. I don't have that anymore. I don't

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Speaker 1: go out really. I mean, I'll go out to see

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Speaker 1: my my kids, my grandkids, whatever, um, run errands, but

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Speaker 1: So it's had a profound effect on her professionally, but

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Speaker 1: even you know, socially and economically. Uh, and not just

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Speaker 1: not just Kelly, but the rest of the family. Um,

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Speaker 1: it has affected me. That's Kelly McCarthy's mother, Brenda Reid.

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Speaker 1: I still get choked up. But what I find is

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Speaker 1: I will feel very sad, only for a moment, but

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Speaker 1: there's still those little flashes, and um, I suspect those

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Speaker 1: will go on for a while. I don't know how long,

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Speaker 1: but it says to me that if something like that

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Speaker 1: it must be for the child, the woman who went

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Speaker 1: important to note that when a patient does spend a

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Speaker 1: lot of time in the I c U, the flowing

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Speaker 1: effects across families is quite profound. A study from France

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Speaker 1: showed that about a third of relatives of I SEE

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Speaker 1: case of Kelly McCarthy, the woman you read about in

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Speaker 1: your story, she was thought to be dying and the

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Speaker 1: saved by reducing the amount of sedation she was on. Yes,

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Speaker 1: so initially Kelly McCarthy was treated in a county hospital essentially,

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Speaker 1: in to say goodbye. We did go and see her,

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Speaker 1: we did say our goodbyes, but I told her to

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Speaker 1: hang on because we were working on something that um

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Speaker 1: would be beneficial to her, and she couldn't hear She

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Speaker 1: couldn't hear us, so we didn't know if she could

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Speaker 1: hear us. As I say, she was unconscious. Around the

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Speaker 1: same time, Brenda, Kelly's mother, learned that double lung transplants

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Speaker 1: were occurring and may offer some life saving benefit for Kelly,

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Speaker 1: and so calls were made to the Brigham and Women's

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Speaker 1: Hospittle in Boston to have Kelly transferred. I had seen

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Speaker 1: a story where at Brighaman Women's they had a lung

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Speaker 1: center and there was a man I believe it was

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Speaker 1: from Nebraska, had come in. Both lungs were gone because

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Speaker 1: of COVID that he had transplants. He survived. He was

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Speaker 1: home in Nebraska doing quite well and recovering, and so

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Speaker 1: we said to the doctor, we want to transfer it.

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Speaker 1: I spoke to Daniella Lamas, an intensive care doctor who

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Speaker 1: took over Kelly's care, and she realized that Kelly's lungs

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Speaker 1: weren't the main problem. She just as Danielle Lamas said,

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Speaker 1: needed to have her sedation turned off or turned down slowly,

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Speaker 1: they did tie trade down all her sedation and opioids

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Speaker 1: and things, and eventually she was able to come off

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Speaker 1: the mechanical ventilator. What do you take away from all

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Speaker 1: this about the lessons that have been learned from this

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Speaker 1: and how in the future the harm that can come

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Speaker 1: from this sort of treatment the well intended can cause.

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Speaker 1: So talking to a lot of folks working in i

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Speaker 1: we can never not allow family he gives back into

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Speaker 1: out a way of keeping that and very important component

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Speaker 1: of intensive care back in the i c U. So

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Speaker 1: that is something that we've really learned from this pandemic,

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Speaker 1: that it's so important to keep family members there in

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Speaker 1: the room with patients. She's just a funny person, but

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Speaker 1: a sensitive person and a kind person. And I watch

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Speaker 1: her now and I always know she was strong and brave,

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Speaker 1: but I watch her now as recovery continues, but at

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Speaker 1: a snail's pace, unfortunately, and the recovery in the end

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Speaker 1: may not be exactly what she had hoped for. But

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Speaker 1: she's doing better now than she was in the beginning,

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Speaker 1: and her her sense of humor does bring her through,

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Speaker 1: but she It's funny because there'll be days when I'll

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Speaker 1: be talking to her and she's very bubbly and upbeat,

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Speaker 1: and I'll say, Okay, you're having a bad day, aren't you.

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Speaker 1: And she'd say, why, why do you think that? I said,

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Speaker 1: I'm your mother, and when you're upset, you're extremely bubbly

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Speaker 1: and outgoing. And she went, yes, I guess I'm having

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Speaker 1: a bad day. So they are in there, but she's

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Speaker 1: her coping mechanism is positively amazing. You can read Jason

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Speaker 1: Gale's story about COVID and sedation at Bloomberg dot com.

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Speaker 1: Jason Gale, thanks so much for taking the time talk

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Speaker 1: to me. Thanks for having me West. It's good to

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Speaker 1: talk to you. Thanks for listening to us here at

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Speaker 1: the Big Take to daily podcast from Bloomberg and I

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Speaker 1: Read today's story and subscribe to our daily newsletter at

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Speaker 1: hear from you. Email us with questions or comments to

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Speaker 1: Big Take at Bloomberg dot net. The supervising producer of

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