When COVID is Personal
March 15, 2021
On Thursday evening December 17, 2020 following a typical day of work, David (not his real name) felt unusually fatigued. He begged off doing the dishes and evening child care duties and went to bed. He awoke at 2am with chills and shifted to his couch. He slept fitfully and shortly arose again with a headache and malaise. David and his wife (both doctors) had experienced non-specific symptoms on occasions over the previous several months that made them think about COVID, but their suspicions did not reach a level that prompted testing. This was different and David was well aware of the protocol developed by his employing hospital. He called his program director to report the need for a temporary replacement on the in-patient service and drove to a designated lab for another nasal swab. He stayed home, wore a mask and self-isolated while awaiting results. The next day he opened his patient portal and read that his PCR analysis was positive for the SARS-CoV-2 antigen. He immediately realized that he would have to quarantine through Christmas and he would miss the excitement as his two young children opened presents. He regretted putting extra strain on his faculty team at the family medicine residency. He was also aware that he could become severely ill. He had witnessed several people infected by this virus progress from mild symptoms to devastating disease since the pandemic was declared in March of 2020. He pondered the irony that he would need to cancel his first vaccination that had been scheduled for December 23.
Early in his isolation David does not recall feeling too bad. He suspects his stresses of making arrangements to put his life on hold may have clouded his awareness and attention to other unusual feelings. He did not keep a journal. He remembers he lost taste and smell and had some nasal drainage and a mild cough but those annoyances seemed trivial. But he soon began to experience episodes of chest pain, tachycardia and dizziness that were not ignorable. He suffered with “brain fog”, headaches and sleep disturbances. As a faculty family physician, David did the natural thing. He began reading everything available about the nature of SARS-CoV-2. So much was being written and his “foggy mind” was soon overwhelmed. He became aware of a previously described postural tachycardia syndrome (POTS) that was being reported in a number of people who had contracted the virus.
The chest pains were similar to the classical description of angina, the warning symptom suggesting myocardial ischemia. His tachycardia spells were usually mild in the 120s to 130s, but on occasions, especially in the shower, his regular heart rate increased into the 180s. He also had other episodes suggestive of autonomic nervous system dysfunction. He would awaken with sweating, gasping respirations and a feeling of panic that made him fear sleep. He wondered how much was psychological, but he also worried about the possibilities of myocarditis or cardiomyopathy that could explain why a 35 year old physically fit man might experience angina and tachycardia. His cardiac evaluations were negative. As time wore on he began experiencing symptoms of gastrointestinal dysfunction. He was frequently nauseated and noticed early satiety. One bite would make him feel full. Sometimes a bite would hang in his esophagus making slow progress to his stomach. Over a couple weeks he lost 15 pounds. He still notices peculiar olfactory sensations. He detects strong odors that are sometimes pleasant but usually unpleasant. Phantosmia, the presence of smell in the absence of stimulus has been reported in association with COVID, but it is not common. Some people notice phantosmia with only one recurring odor, but in David’s case, the odors rotate. He specifically recalls the smells of lemons and petroleum.
He has tried some medicines and medical therapies for his variety of symptoms. Beta-blockers were not helpful for his tachycardia or chest pains. Ibuprofen has been helpful for headaches and Pepcid (famotidine) has helped reduce his gastrointestinal reflux discomforts. The most effective medication was Ambien (zolpidem) that he took for a few days when insomnia became extreme. He once estimated he slept for a total of only 2-3 hours over 4-5 day time frame. All of his short episodes of slumber were interrupted by weird nightmares. His wife has soothed him some with Osteopathic Manipulative Therapy (OMT). His mother, a family medicine psychologist, has helped him deal with stress, anxiety and possible PTSD. The one thing that always helps is extra rest that does not come naturally for David. He shudders to think how he could have coped with his illness without his family, job and income. He has also had immediate access to medical and psychological support. He knows that most people who are infected and symptomatic have few similar blessings. Still his illness remains trying.
He received his first vaccine on Wednesday March 3rd. The vaccination was delayed because experts feared a severe reaction might be triggered in people whose immune systems were already primed. Meanwhile, David had read that some “long-haulers” (people experiencing prolonged symptoms following SARS-CoV-2 infections), reported more steady improvements following vaccinations. At this time, he thinks he has also significantly improved since his vaccination. But, he is hesitant to conclude that his improvement was due to the vaccine. Like most doctors, he has learned to beware of anecdotes and the placebo response.
As his disease now drags on into the 13th week, he is still mildly symptomatic and troubled. He knows he was very careful with masking, gowning, gloving, hand-washing and social distancing prior to his infection. The hospital had segregated people with COVID, but David and his team cared for many people with initially unsuspected infections who were later diagnosed and then transferred to the isolation units. He wants to emphasize how contagious this virus is. And he still worries if he was somehow responsible when his exposure occurred. He feels bad about his separation and limited contribution as a husband, father and son. His feelings of guilt also extend to his work.
He has returned to work almost full time now, but still requires extra rest and support to avoid exacerbating his ongoing symptoms. He paces himself by sitting when he can and taking elevators instead of stairs. He walks some, but has not resumed jogging. He is relieved because at some low times he worried if he would ever be able to return to work as a doctor. He somehow feels fortunate because he has read reports of people who have had continued unrelenting symptoms for over a year. Because the disease is novel, there is no long term data that supports his hopes.
While writing this story I was informed that another of our former residents, a practicing rural family doctor, had contracted this illness and died. He was 52 years old. A moving obituary lauded his dedication and work throughout the pandemic and urged readers to get vaccinated to honor the memory of their fallen doctor and all who have died of this illness.
Last month I listened to a communications scholar from the University of Montana address “The Challenges of Changing Behaviors and Maintaining Relationships During a Pandemic”. One of her points was that “things are not urgent until they are personal”. Most people do not personally know anyone who has died of COVID. Many think the disease has only two outcomes, death or no symptoms at all. Others contend that we are only losing the old and frail who are ready to die anyway. Few have heard of the “long-haulers”. The stories of David and a hard working rural doctor need to be shared.