I am a 65-year-old formerly board certified emergency medicine physician of 24 years who for the last 13 years has worked in a privately owned urgent care center in Lafayette. In my 24 years as an E.R. staff physician, I attended to multiple horrible injuries, illnesses and other medical conditions. Although my current patients usually do not consult us for life-threatening problems, I’m still in the “sick and/or injured” business.
In my entire career as a physician, I have never witnessed a medical phenomenon like COVID-19. And I would have never thought that our government, national public health system and private insurance systems could so comprehensively drop the ball. Given that SARS-CoV-2 is a brand new virus, producing a never before seen illness, COVID-19, I’ll not echo the mistakes of the CDC, supposedly one of the most respected medical institutions in the world, as that horse has been beaten to death. Luckily, our local health officials are not politically motivated and have been extremely helpful to us on the front lines combating this disease. They were extremely helpful in obtaining PPE and testing supplies for us so that we could provide a quality service yielding accurate information. They have strongly advocated hygiene, mask wearing, social distancing and avoidance of high-risk behaviors. Although not foolproof, these measures work. In my opinion, the minimization and politicalization of these measures to subvert their use borders on criminality.
I can’t speak for the physicians who treated the sickest of these COVID-19 patients, but I’m sure it has been horrifying. I see numbers of mildly and moderately sick Covid patients on a daily basis. Occasionally, a seriously ill Covid patient does come wandering in and we send them to the hospital for admission. What concerns me is not how many want to be tested for Covid because of ongoing symptoms or exposures, but how many (a significant minority) refuse to take advice on sheltering in place/quarantine once they have obtained said test. Positivity demands a 10-day quarantine minimum. It also demands a 14-day quarantine of your entire family since they are most likely “high risk.” Failure to heed this advice increases the risk of spreading this disease and prolonging the pain of health restrictions. I spend most of my time advising positive patients of what to expect during their illness: what they’ll undergo with mild symptoms, moderate symptoms, long-term problems, and what to do if it all turns south. A significant number of these patients “don’t have time to be ill” and want to be treated with every variety of non-approved medications. I often feel like I’m pounding my forehead on the concrete.
Let me just say, from personal experience: You really don’t want to get this illness. Its onset is insidious and its clinical course extremely variable. Although the majority of patients will have a minimal to mild course of symptoms that last three to seven days, a significant minority, roughly 20%, will have moderate to severe to fatal illness.
Here’s what to expect with moderate illness that turns for the worse. In the beginning you’ll think you’re just a little tired or you did too much physically and you’ll ignore it, but in reality you are now contagious and the possibility of spreading it to your family or co-workers is definitely there. Then you’ll get body aches, chills, dry cough, fatigue, headache, diarrhea, fever, sweats, chest tightness and increased work of breathing as bad or worse than any flu you’ve ever had. And it will wax and wane for a week or two or longer if you’re truly unlucky. You’ll seek the only solace that you have — your bed. You’ll hope that a friend or significant other will risk their health to make sure you’re OK. And when the end of that first week comes (the critical period when it can all go to shit), you’ll be thinking about your mortality. You will pray your symptoms resolve soon.
So, how did I get myself into this situation? I have engaged in no high-risk activities since the lockdown. My love for nonessential business has been on hold since March 15. No restaurants, live music venues or crowded indoor spaces have been frequented by me or my wife since then. (Disclosure: I do play tennis [risk level 1, 10 being the riskiest] several times a week with essentially the same folks — none of whom are sick, have been sick or got sick from me).
The spike after Phase 2 reopening in June had us averaging 90+ patients a day. The easiest answer is just bad luck while at work. Yes, I see multiple COVID-19 positive patients a day. I wear glasses, head coverings, and an extremely uncomfortable N-95 mask for 12 hours a day. I’m a meticulous hand washer before and after every patient encounter. I clean my equipment. I socially distance while taking my history. My physical exam is the only time I get close to my patients. Multiple low-risk encounters daily certainly must have increased my chances of contracting this disease. It was inevitable. The funny thing is, our Covid positive percentages are markedly down at this point. It will be interesting to see what the mix of Covid with the flu season will bring this fall and winter. I hope for the best, but fear the worst.
Day 1 – Wednesday. I had worked Monday and Tuesday, and we were busy — 150 patients between me and my nurse practitioner (my wife). On Wednesday, I had an extremely physical practice session for approximately 75 minutes starting at 8 a.m. Normally, I’ll eat and rest for a while afterwards and the soreness from playing tennis will be gone by afternoon; only it didn’t go away. I thought it was odd, but at 65 and trying to be athletic, you tend to accept your aches and pains.
Day 2 – Thursday. A late-morning two-hour tennis session was planned. I was a bit more tired and sore than usual, but I made it through. The soreness remained. I went to bed that night and it began. Slowly that burning, aching sensation started all over my body. I didn’t feel feverish, but I had mild chills. The virus was taking over. Sleep was fitful as my mind grasped the possibility that I’d finally come down with Covid. I was scheduled to work Friday and knew I had to get tested and have replacements for me and my wife.
Day 3 – Friday. Myalgias, chills, headache, extreme fatigue, diarrhea, mild cough and loss of appetite brought in the new day. My nurse swabbed me, and I waited anxiously by the Sofia 2 machine for 15 minutes. The tirade of expletives cascading from my mouth was not pretty when the result flashed positive. The symptoms just kept getting worse throughout the day. I got a few hours of relief later that night, but the worst was yet to come.
Day 4 – Saturday. My prior symptoms were playtime compared to what hit me on Saturday around 3 a.m. The rush of body aches, the feeling like my head would explode, chills and fatigue so profound that all I could do was seek the comfort of my bed. My body finally fell asleep about 2 p.m. and I awoke at 4 p.m. drenched in sweat. I felt fine!
Day 5 – Sunday. I felt normal all day long, thinking, well, that wasn’t so bad. I’m through the worst of it, and I barely coughed. I texted my partner. Imagine Kenneth Branagh saying this: “Kirkus of Waterside, I implore you to prepare the leeches post haste as I fear a good bloodletting is in order to remove these evil humors from my body! Please do not delay. Time is of the essence!” I went to bed thinking I was well.
Day 6 – Monday. 3 a.m. came around and my eyes popped open. I could feel the illness slowly creeping back like a balloon slowly being filled with air. And then the chest tightness and coughing set in. I have to admit that my other symptoms were better (aches, etc.), but the worsening cough alarmed me. The critical days after the first week were still upcoming.
Day 7 – Tuesday. Feeling about 40-50% with some wheezing and cough, fatigue, chills, mild aches. Decided to track down my pulmonologist friend to see if he could offer any insights about this. He calmed me down, told me to increase my prednisone dose (I thank him for that). But this thought is still stuck in the back of my mind: Will my case take a turn for the worse?
Day 8 – Wednesday. Groundhog Day. See Day 7.
Day 9 – Thursday. Cough really got bad in the middle of the night. A visit to the office for a CXR reveals no ground glass infiltrates or consolidation consistent with pneumonia. Maybe I’ll get better yet. But the virus has plans for me as it engulfs me late in the afternoon with increasing aches, fatigue, cough and tight chest. The aches are of the severity of Day 4, my worst day with those symptoms. This increases through the evening and gradually subsides to tolerable levels when I lay down at 10 p.m.
Day 10 – Friday. Happy frickin’ 65th Birthday! I awoke at 1 a.m. feeling perfectly fine. Then out of the blue at 3:30 a.m., I’m wracked with shaking, teeth clattering chills that continue for about three hours. I’m left feeling like a twisted, wet dishrag beaten with a club. I’m amazed at how many ways this illness can make you feel miserable! By afternoon, the time of reckoning has arrived. After spiking a temp to 103, my oxygen saturation drops to 90%. I head to the hospital with my new Medicare card in hand where I meet the criteria for admission and the Remdesivir protocol. At this point, my wife, who has been at my side for the duration of the illness, is asked to leave. She is not a happy woman. Remdesivir infusion #1.
Day 11 – Saturday. About six hours after the first Remdesivir infusion, I once again have three straight hours of shaking chills. Come morning, they’re gone. I’m tired. I sleep. I awake feeling fatigued, but not ill. Remdesivir infusion #2.
Day 12 – Sunday. I’m perking up. I watched French Open, read NYT and other news, and wrote some more of this. Weaning down the oxygen. Note to self: Hit the incentive spirometer hourly (a device designed for you to exhale and keep your air sacs open). Maybe I’ll be home mid-week! Remdesivir infusion #3.
Lucky 13 – Monday. Remdesivir Day 4. I’m feeling OK so far. I’m taken off supplemental oxygen. Time to sink or swim. Where’s that spirometer? My oxygen level is holding steady between 92-96%.
Day 14 – Tuesday. I’ll get my last dose of antiviral today. All systems appear to be functioning adequately. I’m heading to the house after my infusion. Per CDC guidelines for hospitalized patients, I must quarantine for 20 days from onset of symptoms. I have six more days to spend at home. Since I was hospitalized, my case is considered as serious, and blood clotting issues are prominent in these cases for weeks after resolution of acute symptoms. To avoid possible sudden death from acute cardiac syndrome, stroke or pulmonary embolism, I must take antiplatelet therapy for a month.
Days 15-20. Post acute illness quarantine. So far, getting to feeling better is a slow process. My energy level is low. I’m light headed with a constant dull frontal headache. I’m short winded, not sleeping well, and my mind is on edge. Some of this is probably related to the Decadron (steroid), which I’m taking for yet a few more days. Patience is a virtue that has been a lifelong challenge for me, but this is not a time to rush things. A good friend suggested that I adjust my goals on a weekly, rather than daily basis. Good advice. I hope to get back to normal soon.
Being in quarantine with COVID-19 gives you a lot of time to reflect. Not only from the boredom of being by yourself, but also because the fitful paroxysms of this seemingly unrelenting illness leave little time for sleep. Time seems to slow down, making each symptom that much more acute, and you think, “How many more seconds can this last?” Your body begs for rest until you’re so exhausted that sleep finally comes for an unsettled while. Sometimes there’s a respite upon awakening, while other times, it’s just more of the same. Hope gets dashed by the abrupt return of symptoms. This scenario repeated itself day after agonizingly slow day. Mostly the same old demons return to haunt you, the mind-numbing body aches that paralyze you in bed. But other days you’re surprised that just having chills can torture you. Hour after hour of body wracking chills and clattering teeth leaving you feel like a tangled mop of flesh ready to be wrung out. Certainly, you’d think you’d learn something from this ordeal. First thing you learn is how resilient your body can be, how much abuse it can take. The next thing you figure out is how strong your will to survive is and how it can carry you through some pretty rough times.
I’m not saying I was “seeing the light” or anything like that, but this was definitely an existential threat. Interesting what comes flooding back into your consciousness at these times — the hopes, the regrets, the successes, failures, your many faults. (Don’t worry, I won’t bore you with those details. My skeletons will remain in the closet.) I wish I could say that I had figured out a way to solve all the world’s problems or even just one of them, but I’m not that smart. I just wish people would try to get along and find understanding and compromise.
The most important thing that I learned/realized was how many people were pulling for me. It is truly humbling to receive this much outpouring of love and support from family, friends, coworkers. Heck, even (maybe I should say especially) my dogs and cats showed me compassion. And I thank you all. I couldn’t have gotten through this without the wonderful care my wife gave me at home, along with the care I got at the hospital from the PPE-clad army of doctors, nurses and assistants. I hope this ordeal will bring me new strength and more compassion for others. I’m grateful that this wasn’t the hill to die on. I can’t wait to be with my family again. Then I’ll get back to work to carry on the fight.
Everyone, please practice patience and respect for your fellow man. It’s a long haul, but we’re going to eventually make it to the other side of this, and it’ll just be a bad memory. May God bless us all.
I think I’ll go to the park
Watch the children playing
Perhaps I’ll find in my head
What my heart is saying
A vision of the child returning
A kingdom where the sky is burning…
— “Any World” by Donald Fagen and Walter Becker
Disclosure: Marc LaPointe is the father-in-law of The Current editor Christiaan Mader. Christiaan was not involved in the editing or review of the letter.