Survivorship
and
success

Survivorship
and
success

Survivorship
and
success

From critical care to obstetrics to rehab: How Sinai Health’s continuum of care saved the lives of a young pregnant COVID-19 patient and her baby.

In January 2021, Janice Nguyen was excited about the year ahead. The then 33-year-old educational assistant was pregnant and eagerly anticipating the birth of her first child. “We couldn’t wait for her arrival,” said Janice. “I was really looking forward to all the milestones — first tooth, Christmas, first birthday, all of that.”

However, everything changed when, at 23 weeks pregnant, Janice became severely ill with COVID-19.

Janice’s husband Samuel rushed her to their local hospital, where she was admitted. Her condition deteriorated, and just over a week later, she was transferred to Mount Sinai Hospital and admitted to the Kimel Schatzky Intensive Care Unit (ICU).

Dr. Christie Lee, Interim Site Director and Education Coordinator for Critical Care Medicine, quickly realized Janice had severe COVID-associated pneumonia. Her condition had worsened to the point that the ICU team decided to "prone"  her.

At that time, very few pregnant patients had required proning. Janice would be among the first. The procedure worked well, and she started to show signs of improvement — a welcome sight for her health-care teams.

As Mount Sinai began receiving a growing number of pregnant patients critically ill with COVID-19, the ICU, in collaboration with the Women’s and Infants’ Health program, established best-practice procedures — now the primary guidelines published on the Ontario COVID-19 Science Advisory Table.

As Mount Sinai began receiving a growing number of pregnant patients critically ill with COVID-19, the ICU, in collaboration with the Women’s and Infants’ Health program, established best-practice procedures — now the primary guidelines published on the Ontario COVID-19 Science Advisory Table.

“Collaborative work is so important in the ICU. We wouldn’t be able to do what we do if we didn’t have multiple teams supporting all the work. We have multiple health-care professionals who work together to take care of one patient. And I think that’s really amazing.”
Dr. Christie Lee,
Interim Site Director and Educational Coordinator
for Critical Care Medicine

Dr. Lee points to the intense collaboration between the ICU care teams and the Frances Bloomberg Centre for Women's and Infants' Health as integral to better outcomes for COVID-19 positive moms and their unborn babies. “It’s a team effort because there are so many nuances with pregnancy,” said Dr. Lee. “These relationships are really important in terms of providing holistic care for the patient.”

Unsurprisingly, Janice remembers very little of her time in the ICU. She recalls understanding she was in good hands and feeling grateful that she was in no pain. While a blur for her, those early months of 2021 were devastating for her husband, mother and brother. “It was the worst time for my family,” Janice said. The daily, sometimes hourly, calls from the ICU team with updates on Janice’s condition were a lifeline.

Finally, after four weeks in the ICU, 20 days of which were spent on a ventilator, Janice was transferred to the David and Stacey Cynamon Mother and Baby Unit. She had survived COVID-19. However, the severity of her illness and the impact of having been ventilated for so long meant she could no longer walk, speak or swallow on her own.

“Right away we worked with Janice’s team of therapists who guided us on how to best care for a patient who was intubated for a long period, which we’re not used to in obstetrics,” said Natalie Lu, a perinatal clinical nurse specialist. “They supported us in getting Janice a special bed and mattress. It was truly beautiful collaborative care.”

Once Janice was out of the critical stage of ICU care, her rehabilitation shifted to the obstetrics team. They collaborated with Dr. Rebecca Titman, a physical medicine and rehabilitation physician from Hennick Bridgepoint Hospital, who worked to create a postpartum rehabilitation plan.

“It was gratifying to see how all the different parts of Sinai Health worked together to support Janice — from critical care to maternal and infant health to rehab. It was wonderful to meet other care providers and work collaboratively in a complex situation.”
Dr. Rebecca Titman,
physical medicine and rehabilitation physician,
Hennick Bridgepoint Hospital

On March 29, 2021 — almost two months after Janice had arrived at Mount Sinai — the moment everyone had been waiting for arrived. Janice’s daughter Flora Joy Vieira was born. Delivered via Caesarean section at just over 32 weeks, she was small and went straight to the Newton Glassman Charitable Foundation Neonatal Intensive Care Unit (NICU), but she was healthy. When Janice first saw Flora, she fell instantly in love. “I was scared to hold her because she was so tiny and I was really shaky. But the nurses reassured me it was okay. I was so glad I listened because it was the most wondrous feeling in the world.”

Dr. Rebecca Titman, a rehab physician at Hennick Bridgepoint Hospital, worked with the obstetrics interdisciplinary team at Mount Sinai on Janice’s rehab plan. “It was one of the smoothest transitions I’ve ever seen for someone whose condition was so complex. It highlighted the importance of communication.”

Dr. Rebecca Titman, a rehab physician at Hennick Bridgepoint Hospital, worked with the obstetrics interdisciplinary team at Mount Sinai on Janice’s rehab plan. “It was one of the smoothest transitions I’ve ever seen for someone whose condition was so complex. It highlighted the importance of communication.”

Janice and baby.

Shortly after Flora’s birth, Janice was well enough to be transferred to Hennick Bridgepoint Hospital. With a treatment plan already in place, she started her rehab journey immediately. Janice was a special case — in addition to having to relearn how to walk, swallow and speak, she had a very specific set of goals for her recovery: learn how to be a mother to an infant.

“As a new mother, Janice was concerned about how she was going to look after her baby,” said Dr. Titman. “We always focus on the patient’s goals, but for Janice it was unique because child care was such a huge part of her rehab.”

For two months, Janice’s days were filled with multiple hours of occupational, speech and physical therapy. She went to visit baby Flora, who had been transferred to the NICU at a closer hospital, as often as possible.

Days before her release from Hennick Bridgepoint Hospital and roughly five months after she had been admitted to Mount Sinai, a reunion on Zoom was held with Janice, her family and members of her care teams from both hospitals. Many of them got to hear Janice speak and see her walk for the first time. There wasn’t a dry eye on the call.

“It was nice to see how much progress she had made,” said Darcy Roza, a speech-language pathologist, who was on the call. “Everything we hoped she would progress to is what we saw, it was emotional for me to see.”

“Janice really touched many of our lives,” said Lu, who was also on the call. “We were so happy to dedicate some time for her send-off. She’s someone we won’t soon forget.”

Today, Janice is back home with her husband and toddler.

Although she is living with whole body ataxia, the result of mini strokes she suffered while intubated, and continues to receive physical therapy, Janice says she’s enjoying life to its fullest. “I’m loving every minute of it with Samuel and Flora. I’m so blessed and grateful for life. My daughter is amazing and the best version of me.”

She also thinks a lot about her Sinai Health care team. “I miss the doctors and nurses. I like to keep in touch and still reach out to them,” she said. “I can’t wait to take Flora to visit them, they’re like my family. I felt very looked after and cared for. They were there when I needed them.”

partners in care

Sinai Health is renowned for its multidisciplinary approach to care. A vast array of health-care teams were a part of Janice Nguyen’s journey, some of which are represented here, and all of which collaborated continuously to ensure best-in-class care every step of the way.

Dietitians

Environmental services

Food services

Medical imaging staff

Medical Laboratory staff

Medical Device Reprocessing staff

Nurses

Occupational Therapists

Physicians
(including critical care, physiatrists, anesthesiologists, ob/gyn, radiologists, hospitalists)

Physiotherapists

Respiratory Therapists

Pharmacists

Social Workers

Spiritual Care

Speech Language Pathologists

Communicative Disorders Assistants

Occupational Therapy Assistants

Porters

Pharmacy Technicians

Physiotherapy  Assistants

Recreation Therapists

Recreation Therapy Assistants

Clerical Support Staff

Biomedical Engineering Staff

Infection Prevention and Control

Partners in Care infographic.
Janice Nguyen cherishes every day with her husband Samuel and daughter Flora, who she says is “the best version of me.”

Janice Nguyen cherishes every day with her husband Samuel and daughter Flora, who she says is “the best version of me.”

Smiling Janice
Baby in Air
After more than five months at Sinai Health, Janice is home. Looking back, she thinks of her care teams as family. “They were there when I needed them.”

After more than five months at Sinai Health, Janice is home. Looking back, she thinks of her care teams as family. “They were there when I needed them.”

PHOTOGRAPHY BY FRANCISCO GARCIA