21 Fall/Winter 2021-22 pull out. But we researched ways we could ambulate these patients, and we developed a strategy.” Two to three times a week, Castro gave his all in slow, small steps down the hall, still connected to the ECMO machine. Each walk involved a team of several nurses, a respiratory therapist, a physical therapist, and an occupational therapist. “Oxygenating blood is exhausting, and there were days he felt fatigued being on ECMO for so long, and he didn’t want to walk or even sit in a chair because, also, he was so depressed,” said Pobanz. In the beginning of Castro’s stay, visitors weren’t permitted. Staff rallied around him, though, giving him extra support and encouragement, so he wouldn’t feel so alone, isolated in the CCU. “We were his only social connection then,” said Pobanz, who spoke Spanish with the Mexicoborn Castro. “I just concentrated on the positive, joking with him about our countries’ soccer teams (Pobanz was born in Chile) to lighten the mood. We all engaged with him, to take his mind off what was going on. And we’d move his bed or turn his chair toward the window, to give him some connection to the outside world.” Sometimes Castro let down his guard and the tears would come. “I felt privileged in those moments when he was very open and vulnerable, while wanting to be strong for his family,” said Tuepker. Then, finally, Castro could have one visitor. That was his wife Amanda, who made the journey from Sandy to the hospital in northeast Portland every day. Soon, Castro’s 20-year-old son, AJ, was allowed to visit. AJ would often help with his father’s ECMO walks, urging him to go just a bit further each time. Several times over his long stay at PPMC, Castro’s nursing team bundled him up for a wheelchair ride outside to feel the sun and see his other children, Marielena, 22; Luis, 17; and Yasmin, 14. “There were multiple times I thought I was losing him,” Amanda said in the video PPMC made of her and Castro the day he left the hospital for home. Doctor Jason Wells, an ECMO specialist in pulmonology critical care at Providence and Castro’s physician, said, “There were lots of ups and lots of significant downs where you know you couldn’t see a path forward for him where he’d make it through.” That was hard for CCU staff, but they bonded through adversity as they have throughout the pandemic. Pobanz, among the 20 CCU nurses on day shifts and another ten who work at night, said, “I rely on my fellow nurses a lot. We started meeting monthly so we could air out our issues and feelings as a group.” Tuepker adds, “Our team is so tight. And the doctors are right there with us.” Tuepker says she draws strength from her faith, prayer, and her family. Long walks outside also help with her stress. Pobanz took up running after watching Castro fight so hard to build strength. “If Alex can walk while on ECMO, I can do a 5K, so I started training,” she said. “I realized I needed to take care of myself, my body, and mind to remain healthy and take care of patients.” By March 2021, Castro made enough progress that he was ready for the respiratory/cardiology department on floor 2R. Nurse Erin Robertson-Otis became part of this care team. She said, “When he arrived, he was incredibly anxious. Patients here still have intense respiratory- treatment needs, and they’ve been through so much more than you can imagine. He was quite fearful to leave [the CCU], understandably, even though that means good things.” The respiratory/cardiology department’s goal is to wean the patient off the ventilator, remove the tracheostomy tube, get them strong enough to move around and, eventually, eat safely. Right across “Watching him leave, I cried like a baby. When Amanda gave me a hug, that’s when I lost it the most.” Tara Tuepker, RN & ECMO Specialist continues
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