Pat Tille, PhD, MT(ASCP)
It is the middle of August and the weather is in the 80s and 90s. There is a global pandemic, so all your interactions are limited only to those you share your household with or close family, due to assisting with childcare or other needs as you can. Activities outdoors are “safer,” because you can more easily socially distance and have much better circulation. Everyone has been wearing masks when going to places like the store for groceries and not attending any major events or large group gatherings. And then it happens.
You wake up one day and your nose is stuffed up and you have a sore throat. You wait a couple days thinking it is just a short-lived event because you have been going between air-conditioning and heat. Symptoms do not resolve so you visit your family care provider. The provider does an exam, looks in your ears, your nose, your throat and says you clearly have a sinus infection. You ask if you should get tested for COVID-19 and the provider says, nope this is clearly bacterial. The provider prescribes Augmentin and a steroid, which you know from previous experience has the potential to cause serious gastrointestinal (GI) discomfort and diarrhea, but you figure you will try it.
After five days you cannot eat and are struggling to take in enough fluid. You begin to feel weak and light-headed and figure it is time to stop the antibiotic and maybe go in and get some IV fluids to rehydrate you.
In the emergency room (ER), the nurse comes in and checks your vitals. She places a nasal canula on you underneath your mask with two liters of O2 and leaves the room. The ER physician comes in and goes through your signs and symptoms with you and says he wants to do a computed tomography to check your colon, etc., and collect a stool sample for Clostridiodes difficile. In the meantime, you are given a bag of IV fluid, an injection of Zofran to reduce nausea, and a shot of morphine for discomfort. You come back from radiology, and the provider pulls up the digital image from the CT. He says your GI looks great, but it is this in your lungs that is concerning.
Well, being the healthcare professional that you are, and a microbiologist who has been reading and watching the pandemic for many months, he had to say no more. In both of your lungs there are some patchy areas that are quite diffuse and clearly evidence of viral infiltrates. The provider says this is a concern and begins to question you about your breathing. After about two hours from your initial arrival in the ER, the provider realizes you have a nasal canula with O2. He asks when you put that on. You calmly respond that the nurse did it after your initial vitals. The provider says, he thought you were wearing it simply because morphine can cause a drop in your saturation levels, but it returns to normal within a reasonable time. The provider says he is concerned and is thinking of admitting you to the COVID-19 acute care ward. Of course, you have no intention of going there, and ask why. He says, because your oxygen saturation is not staying above 88 percent, even on two liters.
“It has been almost four weeks since I entered the ER with an expectation to receive some IV fluids and be sent home. I am still required to have one liter of oxygen at night while I sleep to prevent my oxygen from dropping.”
The Acute Ward
Well, if you have not been paying attention, going to a COVID-19 acute care ward has not met with very positive news coverage. The stories of lack of personal protective equipment, the crowded halls with equipment and people, and no visitors is enough for you to not ever want to see the inside of one of those wards. Unfortunately, I was headed that way. It took another hour before I was taken from the ER out to the back-ambulance elevator and shuttled in a wheelchair through some back hallways to a set of double doors to the COVID acute care ward.
Upon entering the hall, my worst nightmare became reality. There were carts of equipment lining one side of the hall, from scales to weigh you, to carts of syringes, IV tubing, coban, and every disposal medical supply you can imagine. In addition, there were crash carts, portable oxygen tanks, and computers on carts. I was put in a room that had one small window, reminiscent of a hospital room from the 1980s. There were no modern electronics for patient care, no automatic blood pressure cuff, no pulse oximeter, no modern health-care equipment. Eventually, I was fitted with a portable battery-operated pulse oximeter that the nurses connected via blue tooth to a monitor at the nurse’s station.
Shortly after my arrival, the primary COVID acute care ward physician came in and introduced herself. She looked at my chart and explained how there is no cure for the virus, but they were going to do what they could for me. She said, I will have the nurse bring you some paperwork, so we can begin to treat you and hopefully you will improve.
By now COVID has been around for more than six months, and I had done enough reading that I simply looked at the physician and said, “Hit me with everything you got from Remdesivir to convalescent plasma, because I am going home.” If the trip from the ER to the floor was not depressing enough, the hallway, lack of equipment, and isolation room most certainly would be enough cause for any average person to have high anxiety and potentially a panic attack at this point. The positive part of this whole experience was that the physician had a solid treatment plan that she insured was put into place in less than a few hours following my admission, but that is another long narrative.
It was not more than eight hours, and I could not even walk to the bathroom without my oxygen levels dropping so low that the nurse would come in, and over the first few days, my two liters went up to five liters. It seems from talking to the nurses that I was somewhat unusual; I had no other symptoms that have been associated with COVID other than the diarrhea I had complained about when arriving in the ER.
The Long Road to Recovery
After four days of treatment, physical therapy, occupational therapy, and a sleep study, I was released on day five with an order for oxygen therapy at night to prevent my oxygen saturation from dropping too low. I was also put on a daily home monitoring system and required to log my temperature and oxygen saturation twice daily. I also received daily calls from a nurse to monitor my recovery. I was able to keep my oxygen off during the day, as I was now holding at around 95 percent saturation. But even with that, the smallest amount of activity would cause it to drop rapidly to 91 percent and increase my heart rate at times above 130 beats per minute.
My husband, who was also COVID-19 positive, had only experienced what he described as “hangover like” headaches for a few days while I was hospitalized. Because of his minor symptoms, but requirement to quarantine, he was able to help me around, help me shower, and ensure I was getting three meals a day. For the first week, I was not able to do much—even working on a computer—without the need to take intermittent naps to regain my strength. After that first week, it seemed my fatigue decreased, and I slowly began to be able to manage tasks more on my own.
At the time of writing this article in early September, it has been almost four weeks since I entered the ER with an expectation to receive some IV fluids and be sent home. I am still required to have one liter of oxygen at night while I sleep to prevent my oxygen from dropping. I keep a pulse oximeter near me always and check my oxygen saturation because COVID-19 can cause rapid unexpected drops without any prior symptoms. I still get short of breath, and some of the daily activities can be overwhelming at times. Some days I feel almost normal, and other days it seems like I just need more rest.
It is still early, and despite that I am counted as a “recovery,” since I received clearance from our state public health lab, the word recovery seems so inappropriate at this point. I have no idea how long this road will be or how it will end. During this period, eight out of 16 family members, including myself, had their own experiences with COVID 19—from my one-year-old granddaughter and other grandchildren, to two of my own children, with one also being hospitalized three days after my release, to my sons-in-law, husband and myself, both 61 years old. The COVID-19 story for all of them, is different from my own. When I was released from the hospital my primary provider told me “I was lucky.” I guess time will tell.
Pat Tille is Associate Professor and Graduate Program Director at the University of Cincinnati College of Allied Health Sciences and lives in Sioux Falls, South Dakota.