Jessica's Story
Having lived with decreased heart function since childhood, Jessica Ziemba, 44, has had a pacemaker – a small, battery-operated electronic device implanted under the skin to regulate her heart's rhythm – for most of her life.
Because pacemakers need to be replaced periodically, Jessica knew exactly what to expect when she went to have her old device swapped out for a new one. The Cleveland Clinic nurse and mother of three assumed it would be another easy “in and out” procedure. She hugged and kissed her young children, telling them she’d be home in three days.
She would remain at Cleveland Clinic Main Campus for over four months.
During surgery, there were complications. Jessica developed superior vena cava syndrome, a condition where the flow of blood through the large vein that carries blood from the upper body to the heart is blocked. This required surgeons to perform an emergency sternotomy, which involves cutting through the sternum to access the heart so they could repair damage to two of Jessica’s major heart vessels.
Due to the stress the procedure caused to her heart, Jessica was placed on extracorporeal membrane oxygenation (ECMO), a life support system that provides oxygen to the blood and removes carbon dioxide when a patient's heart or lungs are too severely damaged to function properly.
Unfortunately, while ECMO was keeping Jessica alive, she began to experience kidney failure, which caused a buildup of waste products in the blood. For that, Jessica required dialysis, a treatment that filters waste and excess fluid when the kidneys cannot function properly.
Jessica was on ECMO for nearly three weeks while her heart and lungs rested and healed. It would be another few months until she was medically stable enough to begin planning the next steps in her recovery. The choice to pursue an intensive inpatient rehabilitation program at Cleveland Clinic Rehabilitation Hospital, Beachwood was an easy one for Jessica and her family – it was close to home, and she had heard positive things about the hospital from her co-workers at Cleveland Clinic.
Her extended hospitalization left Jessica with decreased endurance and balance, and she had lost significant muscle mass. She had difficulty getting in and out of bed, walking more than 60 feet with a walker and became easily out of breath while performing her personal care tasks. “I was excited to be one step closer to going home,” Jessica shared upon her arrival. “But I was also nervous about how I would be able to handle the intense therapy knowing how weak my body was.
Jessica’s primary goal was to walk independently so could attend her kids’ sporting events. With that goal in mind, Jessica’s physician-led care team of nurses and physical, occupational and speech therapists, worked to create a personalize care plan to get her back to her life.
Physical therapists initially focused on building Jessica’s strength, balance and endurance. To do this, therapists had Jessica improve her walking tolerance. First, they had her practice standing and walking in the parallel bars. Jessica was then able to progress to a height-adjustable platform walker, which is designed to provide support for patients during early walking exercises. Eventually, she was able to move to a standard rolling walker. She also practiced stair training, initially with lower steps in the parallel bars so she could hold on for support. Eventually, Jessica was able to complete a full flight of stairs while holding on to the railing. Jessica also used resistance bands and ankle and wrist weights while she practiced going from sitting to standing to improve strength.
In occupational therapy, Jessica’s team managed her fatigue so she could work on performing her personal care tasks. They practiced bathing and dressing while educating Jessica on techniques to pace herself and conserve energy. Jessica had many of her occupational therapy sessions in the hospital’s activities of daily living (ADL) suite, which mimics a home environment. In the ADL suite, Jessica built up her endurance and independence while practicing household tasks. As she progressed, Jessica was able to complete her normal duties like cooking, setting the table and laundry without using a walking device.
The first time that Jessica’s children came to visit her at Cleveland Clinic Rehabilitation Hospital, they were nervous to see her. She hadn’t been home in over four months after they thought she’d be home in a few days. To help make the visit a positive one, the hospital’s recreational therapist arranged a special after-hours painting session with Jessica and her children. Nervousness quickly turned into fun, making the first visit and those following more comfortable.
Jessica’s whole family, including her husband, children and parents, participated in family training so they could learn how best to support and care for her physically and emotionally once she returned home. Jessica’s rehab stay was an emotional one. “I didn’t know if I was going to make it through something so serious and life-threatening,” she said. “I’m stronger than I thought I was.”
That strength was demonstrated in the great improvements that Jessica made during her 19 days at Cleveland Clinic Rehabilitation Hospital. At discharge, Jessica was able to walk 180 feet independently both with and without a walker. She was able to complete a full flight of stairs with supervision while holding a railing so that she could get to the second floor of her home. Jessica could also bathe, dress and perform all of her personal care tasks without assistance.
“It was life-changing,” Jessica said about her time in inpatient rehabilitation. She plans to continue to build upon her progress with outpatient therapy and is looked forward to sleeping in her own bed and being back at home with her family. Jessica also had some words of advice for others facing a difficult recovery: “Keep going. Change isn’t going to happen overnight, but it does happen.”