I’ve Had It

It started with a young couple who had just come off a cruise from Mexico with an awful cough they couldn’t shake. They coughed all over me. I saw several more patients with similar illnesses coming back from cruises to Jamaica, the Caribbean, South America…

But no one from China.

That was near the end of February.

The first day of March I started with a bit of hoarseness. It lasted for a few days. I didn’t feel bad at all but I sounded awful, barely able to croak out a whisper.

Then there was a tickle in the back of my throat.

Sometimes the tickle would trigger a coughing fit… a coughing fit so bad I would have to excuse myself from a patient room to grab a drink of water. The cough was always nonproductive. No nasal congestion. No runny nose. No postnasal drip. On the plus side, my voice was back. I’d had this happen before with spring allergies, given the fact I probably had a mild case of seasonal asthma, but oddly, the cough went on for well over a week. I really didn’t feel bad per se. It was just that silly cough. I still didn’t think I was sick.

Until the fevers started.

The fevers came and went and they went on and on. 101. 102. Down again to 100.4. Early morning and late evening seemed to be the common times it would spike. Fatigue. Shortness of breath. I got an inhaler and started using it. I took a steroid pack and an antibiotic. Cough pills. Allergy meds. I took a second antibiotic. I got a chest X-ray.

Nothing seemed to help.

I stayed home for a couple of days when the fevers started but after that, I felt I had to go back to work. Tons of pressure to work. Pressure from corporate, the clinic staff, my office manager, patients, myself. I didn’t want to be called lazy. Or a wimp. Or a malingerer.

So I wore a mask. We had a stash of N95’s and I wore one the whole time I was working. I felt OK with that until one day I started the morning with a patient on oxygen, the next patient had lung cancer and was getting chemo, the next was a frail 90 year old. It spooked me.

What if I make all of these people sick?

What if I killed them by being in the same room with them?

I called the local health department to ask if I could be tested for coronavirus. They were the only ones with tests at this point. My hands were shaking as I made the call. I was terrified of the medical and social implications. A doctor testing positive would no doubt make the evening news. Stigma. The answer from the health department though? Absolutely not. No testing for me. I couldn’t possibly be infected, they said. No exposure to someone recently returning from China and no exposure to a known positive COVID patient.

Corporate, though, got worried and forced me to go home. Honestly, I have worked while I was much, much sicker. During residency it was always emphasized that we had better be present at the hospital rounding on patients unless we were the patient being rounded on. Or dead. We could be dead and that would be a reasonable excuse…

The following weekend, still running fevers, I had a spell where my heart felt like it was racing out of my chest and I dang near passed out. I had to call out to my husband to keep me from falling over onto my face. It passed after a minute or two and I successfully talked myself and him out of a trip to the ER. The whole spell was probably just my imagination going crazy, right?

Interestingly, food did not taste right at all. I felt like that was probably due to all of the medications I was taking. This was before smell and taste changes were identified as part of Coronavirus.

The fevers finally stopped after 10 days. All said I had been acutely ill for over three weeks. I was finally allowed to go back to the clinic. The first thing I did was to call all of the patients I had seen while I was ill to make sure they were OK. They were. Thank God for N95 masks. I still had a cough, though. I still had to use my inhaler. Walking up even a low, gentle hill was just not possible. It took a few more weeks to have all of THAT pass. I have never had something like this hang on for so long. In some ways, I felt more debilitated after the fevers were gone than I did during the acute phase. The whole episode had felt so strange, not like any illness I’d had before.

By then, my clinic was turned into a respiratory clinic. People suspected of COVID were sent to me for testing. My mind would go to dark places almost every day. What if what I’d had was NOT actually coronavirus? Would I get sick? Was I going to die? BUT then I felt that if anyone had a chance to have immunity, it was me even if we didn’t know positively. So I made sure I was the only one doing all of the testing, keeping my staff away from being exposed to patients who were ill.

All the time, I wondered. I have wondered for over five months as I have watched some of my patients die or end up in ICU as they fell ill.

Yesterday, I was told that I AM positive for the antibodies. Testing was performed as part of a healthcare worker research study. I don’t know how high my antibody levels are, only that I have them. No one else in my clinic has antibodies. Is it possible that I had an asymptomatic case later? Sure. But I believe I was one of the first in my area in early March with COVID-19.

There is a huge weight off of my shoulders, now. I did not realize how much the fear and doubt were weighing on me until it was gone. How much immunity I will actually have, especially at this point, I don’t know. But I do know this:

I survived COVID.

And?

If I did it once, I can do it again.

Paradigm

If one could say there is something good coming out of the pandemic it is this:

Medicine has been forced to rethink how it delivers care.

After begging for telemedicine access for years, BOOM! I have it. After being told I cannot see patients in their homes, BOOM! It is not only allowed, it is smiled upon.

I spent most of the day yesterday seeing my patients in their cars. I had regular patients that don’t have access to telemedicine out front in the morning and Covid suspect patients out back for testing in the afternoon so I was not going back and forth putting people at risk. In between I was seeing patients via telemedicine.

It struck me as I stood in the sun for a few hours that I need to start wearing sunblock in my moisturizer or I am going to get a fascinating N-95 tan line on my face if this keeps up. The temperature was close to 90 degrees (that’s 32 degrees to the majority of the non-US world) and I had ice packs in my pockets to try to stay cool in the sun while dressed in a long plastic gown with absolutely no ventilation. Dehydration could be a risk as the summer progresses and temps get up over 100 degrees (37 degrees Celsius). I can’t just take off everything to swig down some water and then pop it all back on.

But I am not complaining! I am getting to be creative, feeling like I am actually doing something productive and meaningful on a level I have not been able to experience since residency. Are there risks? Sure. But that makes it spicy.

I have not been able to respond to comments as I would like and I am sorry for that. I will catch up when this is all over and things have slowed down.

Call of Duty

How do we stay connected as humans beings as we retreat from our patients and from each other behind gloves and masks and face shields?

I have been pondering this.

Back in the day when I was doing inpatient medicine, if I knew someone was dying and there was no one to be there with them, I would go and hold their hand until it was over. The thought of dying alone is very upsetting to me personally. I don’t want to be alone. I don’t want anyone else to be alone.

Hospitals right now are not allowing visitors at all. If your mom or dad or sister or husband gets admitted, no one can come in with them… they are alone.

We have made plans for COVID dedicated hospitals in the area. I am on the list to help out at one should the need arise so I have been brushing up on ventilator management. That part does not scare me. God knows when my time is up. I won’t be reckless. I just know that I could walk through a room full of coughing COVID patients without PPE and if it isn’t my time, it isn’t my time. But knowing that if we are overrun, I may not have the opportunity to linger at the bedsides of those on their way out really bothers me.

I wonder what all of this is going to do to us. What will the world be like in the other side, when the danger has passed? I don’t feel like a hero. It bothers me when people say that I am. This is my job. This is me being human. This is what we are called to do, to care for others. All of us has an opportunity to be a “hero” to someone right now. Whether it is giving food or money or emotional support to those who need it or caring for someone in a hospital bed. They ALL carry risks. It is easy to hide behind a door, a mask… to disappear.

Don’t disappear.