The coronavirus pandemic has turned the world, and all of its citizens, around, never to be the same again. As an ICU and ventilator survivor, I focus on the drama of the patient’s room, and the reality of what is truly a tragic experience. Nineteen-ninety-eight seems like yesterday, and while it was 22 years ago, it is fresh in my mind.
The vacation abroad that fall was a sunny respite from my busy urologic practice. Food and fun flourished, as my family and I had a relaxing week. When I returned home, I was not feeling well. It was GI distress, perhaps courtesy of a street vendor. Of course, I did not bother to seek medical care. “I am a physician, not a patient,” I often remark sarcastically.
When I awoke that night with rigor, a shaking chill, and a high fever, I knew the significance immediately. A local trip to the emergency room, and subsequent emergent ride in an ambulance to Kaiser Permanente-Riverside, soon followed. Antibiotics, steroids, and blood-pressure support began empirically. I was now the proprietor of wide-open IV fluids and Trendelenburg position.
It soon became apparent that I was experiencing septic shock. O2 saturation — profoundly low, and a dangerously low BP, characterized my condition. Renal shutdown with anuria, leukocytosis, and thrombocytopenia, reinforced the grave diagnosis.
I dabbled at the thought of a quick escape from the unit. I seriously considered a quick toss of a chair, through a tinted second-floor window. This thought was bizarre but extremely appealing to my rapidly dysfunctional mind. Within an hour, I was awake intubated, reeling from profound respiratory failure.
Soon, I had full-blown sepsis. Six painful weeks of massive resuscitation, arterial lines, Swan-Ganz catheterization, steroids, triple antibiotics, and medical support were eventually required. Pulmonary ARDS, hypotension, DIC, chest tubes, a tracheostomy, and liver and renal dysfunction all characterized my hospital course.
ICU psychosis ruled my mind. Dreams filled with demonic like spirts, and life-threatening scenes flourished. Executed before my eyes, was a thin, jazz patch wearing African American. Fright, fear, anxiety, isolation, sleep deprivation — all characterized this catastrophic period of my life.
The ventilator, while necessary in respiratory failure, was not pleasant. Fighting the ventilator’s insufflation is inherent in any semi-awake respiring patient. Pharmacologic paralysis and heavy sedation combated this. High PEEP and airway pressures predict for the painful chest tube. Profound hopelessness and overwhelming discouragement settle on the patient.
I was haggard, weak, and feeble after losing 40 lbs. Sitting upright, standing, and of course, walking was for the time impossible. Airway obstruction with an inability to uncap the tracheostomy plagued me continually and contributed to this global fright. My wasted hands were too weak even to depress the call button. Panic was champion for this recovering patient. I would not wish the same condition on anyone.
The recent COVID-19 pandemic, with infections and viral septicemia, still return visions too vivid for my mind. Sepsis, with all of its manifestations, is the common denominator in a significant number of these patients. While treating physicians manage the clinical course, let’s recall the patient’s humanity, and first, do no harm.
William Lynes is a urologist.
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