Covid-19: When the Doctor Becomes a Patient

Spring was supposed to be busy: five wound symposia (one international and four around the country), a family vacation, a tennis season for one child, and a finishing line for the college decision for another. I planned my neonatal intensive care inpatient service and overnight calls carefully to accommodate all those events. In the beginning of March, Covid-19 had landed in New York City and Long Island. My hospital issued a memorandum that surgical blue masks were to be worn by all front-line employees. I was working an overnight shift at our level 4 NICU. Many were complaining about the masks, but others (including myself) were happy. We were worried about deliveries involving Covid-positive mothers, potential transmissions to babies, and multiple visitors to the NICU who could be potential Covid carriers. Otherwise, it was business as usual. 

Many conferences and meetings around the world were being canceled. As the weeks progressed our administration stopped all international travel, followed shortly by the cancellation of national travel. I felt so frustrated. All the planning, the tickets, and the work that went into presentations … forgotten.

Two weeks before I was diagnosed, I found out during one of my overnight shifts that some medical personnel from our unit were out sick with Covid-19. The adult floors of the hospital were filling with Covid-positive patients, and the intensive care units and emergency department were overwhelmed. We were running out of ventilators. The sense of worry was palpable. That night was the first night I had to go to a preterm delivery for which the mother was likely Covid-positive based on her symptoms. That same day we received a few N-95 masks and face shields for these deliveries. I put on my attire and waited for the baby to be delivered. The mother was coughing constantly. The baby was covered in secretions (who knows if Covid-19 was in those secretions), and everybody in the room was in the fog of the unknown. That was the night that the rules changed drastically for us and for many other hospitals in the New York City area. After that there were no more visitations on adult floors, and mothers would no longer have their partners stay with them after delivery. NICU visits became limited by time and only by 2 designated people, as we found out that some parents who visited in prior days turned out to be Covid-positive. Overhead rescue teams were called to the Covid-designated floors so often that it gave you an eerie feeling. That was the week during which I was exposed to Covid-19. Nothing has been the same since.

I was the clinical attending on-service in the NICU for the next 2 weeks. I enjoyed the hectic yet controlled rhythm of the NICU, the challenges and the teaching aspects. Masks were a prominent fixture, and I blamed poor air circulation for a headache I had all day on Wednesday. On Thursday the headache got worse. I barely finished patient rounds and went to the office to take an analgesic. The pain was right behind my eyes, like nothing I have ever experienced. I checked my temperature, and it was normal. OK, maybe just a headache. By the time I came home I felt wiped; I worried, but my temperature was still normal. Maybe I just needed a good night’s sleep. By 10 PM I felt flushed, and then came the 101.1°F fever. I called work to let them know that I was febrile and could not come in. I told my husband and kids to put on masks, don’t come near me, take vitamin C, and disinfect surfaces and doorknobs. I also made an appointment to be tested.

I had the test done the next day amidst fever, headache, myalgias, and feeling like I had been hit by a truck. I had never experienced exhaustion like this. Raising my head off the pillow was like heavy weightlifting; walking across the room was a challenge. The fever and the shaking chills were relentless. Tylenol did nothing, and there were speculations that NSAIDs might be dangerous if a person was infected with SARS-CoV 2, but I alternated them anyway as my fever was up to 102.8°F. I was drenched in sweat with cold, wet towels all over me, in the hopes that they would break the fever and give my body a break. These first few days are still a blur.

Most of my hours were spent sleeping or in a brain fog so sick that watching TV was impossible. On day 3-4 the dry cough began—not horrible but enough to make me want to hide from my family knowing that I could spread respiratory droplets. Talking became a challenge, and I would get short of breath even after a minute. My chest felt tight. Looking back, I wonder if hypoxia was my roommate during those days, but I didn’t have a pulse oximeter at the time to check. 

I remember constantly thinking, “Should I be treated?” My physician was not sure. In New York one needed an official positive test result to prescribe hydroxychloroquine (HCQ), the treatment du jour at the time. Meanwhile, I checked the Urgicenter portal for my results daily…nothing. 

On day 5 I called the center. “Yes, you are positive,” the physician said, sounding very surprised that I didn’t have my results yet. “Sorry, I guess there was a glitch with the system.” 

Seriously? Through the pain, my anger rose. 

“You have delayed my potential treatment for days,” I told her. 

“You sound short of breath,” she told me. “Let me prescribe an inhaler for you.”

That night the symptoms became unbearable: pain, fever, tachycardia, shortness of breath, and fear. Definitely fear of the unknown, but also fear of the facts. The facts that nobody understands this virus or knows how to treat it, that the treatment may have serious sequelae, that I can infect my family, and that staying alive is not a guarantee.

On day 6 I called my internist and asked for medication. I told her that I didn’t want to go to the ER or be admitted but that the symptoms were relentless and I couldn’t go on the way I was. She warned me about the potential side effects of HCQ (arrhythmia, retinal damage, and gastrointestinal symptoms) but called it in with the Z-pack and folic acid. Four pharmacies around me were out of it. The frustration from helplessness and the mental fatigue from uncertainty of the next step felt defeating. I am the one who normally gives advice, prescribes medicines, and offers hope, yet I can’t help myself.  Then a close friend found a pharmacy in New York City that had HCQ. My husband brought it home, and as I took the first dose my hands shook from fear. I prayed that it would help and not further injure my already ravaged body. The only other thing I was capable of was sleeping for 14 hours a day.

The mental anguish that came with Covid-19 is difficult to put into words. Most would consider me to be a fairly tough, calm, and a cool-headed physician. Those qualities left me and were replaced with uncertainty, anxiety, and indecision. On day 3 of HCQ treatment (day 8-9 of illness), I experienced blurry vision, palpitations, tachycardia, and what felt like an irregular heart rhythm. Was it Covid or the meds? Should I take the next dose? I reached out to other doctors, who offered opinions but just opinions; the literature and articles at that time were not “good-science” quality, although anecdotal stories and homeopathic suggestions flooded the Internet daily. 

The days blended together. When April arrived, we were in the middle of the worst numbers in New York. Watching TV made me too anxious, so I stopped. Acquaintances and family members from other states texted me to find out “the true version” of the horror they see on TV. Most of the time, I did not share that I could barely walk or talk but I did say, “Yes, the stories are true.”

Despite the pandemic, consults for wounds keep coming.  PI from tracheostomy ties in the pediatric ICU, extravasation in the NICU, a burn, a rash, and nurses with skin broken from masks. During rare moments of subsiding fever, I answered in short sentences: “I am not available but try this…” Sometimes I chuckled because this was the only part of normal that I had left (my phone and email usually never sleep, not even on vacations). So even during this horrible illness, I was still wearing the wound doctor hat. I guess a doctor and a patient can co-exist.

The fevers subsided after day 8-9. I finished the 5 days of the Z-pack and the HCQ. My headaches were mostly gone, and I could walk up and down the stairs (with an hour recovery after). I actually answered some emails. It was amazing how fatigued my brain felt after reading an article for 5 minutes. The other amazing parts were texts and phone calls from my friends and colleagues… closest ones many times a day, others daily and weekly. Their prayers and wishes helped me through the worst moments, as they kept encouraging me despite my daily bad news and my moments of lost faith, fear, and tears. For that I will always be grateful.

I slowly regained small moments in my daily life: cooking simple food, staying awake for more than 3 hours, taking a shower. My sons walked outside with me, first for 5 to 10 minutes and then for 15. It took me 2 hours to recover, although only 4 weeks before I had trained for a half-marathon. To make matters worse my chest was still tight, I felt like I couldn’t take a deep enough breath, my heart hurt, and palpitations came and went. I tried to make an appointment with my internist to get an EKG, but because my cough was still present, all that would be possible was a virtual appointment. The symptoms were always worse at night, further disturbing my sleep.

In the outside world, the evolution of Covid-19 discoveries reported worsening cases after a few weeks of improvement, hospitalizations and death in young people for no apparent reason, small vessel thrombosis due to hypercoagulation, heart injury, strokes, and renal failures. Some evenings my pain and palpitations seemed unbearable, and I started to worry that I was missing a heart attack. I managed to obtain an appointment with a cardiologist and then a pulmonologist. Both said there was nothing too serious that they could see in my test results, yet my symptoms persisted. The inhaler was not helpful and neither were anti-inflammatories. 

Week 5 rolled in with an evening of 10/10 pain in both my chest and back. The next morning I was back to see my doctor and was willing to be admitted to the hospital. All I wanted was a diagnosis, an answer, a plan, and an ounce of reassurance that one day it will go away. I underwent a CT angiogram to rule out pulmonary embolus and a hypercoagulability work-up. I tried to be a gracious patient but being stuck 5 times for an IV is maddening. Some of my blood tests couldn’t be run, and I had to go back to the lab. By that time, I had no veins left and black hematomas all over. I was done being a patient and wanted to go back to my doctor role. 

During that time I answered every text and email consult, clinging to the moments of normalcy. Clinical evidence was growing in the Covid-19 literature for small vessel thrombi; maybe that was what was causing my chest symptoms. Cases of myocarditis, pericarditis, and cardiomyopathy after Covid-19 were then reported in previously healthy individuals...my symptoms could be pericarditis. Both docs honestly told me that it was not a clear-cut picture. I pray that this injury or inflammation is reversible. A new medication regimen was prescribed. As I write this, I am now on week 7 of this Covid-19 journey. 

It has been almost 60 years since the last pandemic of influenza in 1968. People who survived are now the prime targets of Covid-19. Medicine evolved so much and yet it didn’t. All we can offer as prevention is quarantine and face covering, exactly what they had in 1968! The treatment or complications etiology situation is even more dire.  The truth is … we just don’t know enough yet. Why some patients are asymptomatic and others have severe cases. Why some recover and others develop sequalae. Why previously healthy hearts and kidneys get injured. Are treatments making these injuries worse? We just don’t know and until we do, the research has to continue and the industry should be challenged to produce and provide better protective equipment.

I am slowly getting back to my “doctor life.” I have ICU shifts, and I see wound patients. I give neonatal lectures, and I return to my papers. But I also know that the biggest lesson learned during this terrifying journey is not about work. As professionals we often pride ourselves on “being busy”; we postpone simple things such as a walk, a board game, cooking together, or just talking. The lesson is this: don’t postpone these things. Nobody has a guaranteed tomorrow. Make time for the ones that really matter in your life!