木瓜直播

After my big reveal last week that I had contracted and recovered from COVID-19, many people sent in wonderful comments to 木瓜直播 or contacted me directly saying how happy they were that I was better, and asking what the course of the illness had been like.

So I thought it might be interesting to go through my own clinical experience, describing how I felt, what I did, what worked and didn't work, and hopefully adding to the ever-expanding knowledge base we have about this terrible, crazy virus.

And if those reading this have had the virus and want to add to the conversation, please feel free to add comments.

How Did I Get It?

Thinking back on the few weeks before COVID-19 really broke on the scene in New York City, we had been seeing lots of patients with fairly typical late-winter and early-spring coughs and colds, and many people came in telling us they'd recovered from a cold or were getting over the flu, and just wanted to get checked out.

No one was thinking about asking about anosmia or ageusia, and community spread of COVID-19 was probably already rampant.

My suspicion is that somewhere in there, before we started seeing almost every patient fully decked out in personal protective equipment (PPE), was when I was exposed to an asymptomatic or recovering or full-blown viremic COVID-19 patient, before we knew what that was or were expecting to see it come in our door.

Or maybe I just got it on the crosstown bus.

These days, everything's COVID-19, all the time. As we are discovering the protean manifestations of this illness, it seems like that's all we're seeing in the office, in the emergency room, on the floors of the hospital, and even in televisits and video visits. The anchoring bias makes everything COVID-19; what else could it be?

But then, just as COVID-19 started to rear its ugly head across our beloved city, our institution ramped up surveillance, and we started asking about possible exposures and travel history. It was also recommended that all providers check their temperature twice a day, before coming to work, and at the end of the workday.

I was afebrile Monday morning, and Monday night, and Tuesday morning. I spent both of those days seeing patients in our newly established cough, cold, and fever clinic, but was fully protected with PPE, and so I don't think that's when I got it.

At some point during the day on Tuesday my wife called me, saying she was being sent home from Grand Jury duty with a fever. Because of the way Grand Jury duty works, they had 20 to 30 people in a room together, without strict social distancing, and she had said that in the previous week lots of people seemed to be sick, with sniffles and coughs and other cold symptoms.

Still asymptomatic, I finished up the workday and walked home on my usual route through Central Park. However, when I got home, I remember being hit with a wave of extreme fatigue, and suddenly felt like I really needed to take a nap. An hour and a half later, I woke up rigoring, and checked my temperature, and it was 101.8 degrees.

Well, that pretty much does it. I think I'm going to be out for a few days with COVID-19.

Three Hellish Days

I called one of my partners, and told her that I was probably not coming in tomorrow, that I probably had COVID-19, and that I would keep everyone updated on how everything was going. I had a thermometer, a pulse oximeter, some Tylenol and Aleve, and figured I would just have to ride it out.

The next 3 days were pretty hellish.

The cough was incessant, pressure deep in my chest, initially a lot of thick sputum, but later just this nagging dry cough that wouldn't go away. I've had a lot of people describe their breathing as "restricted" or "suppressed" or "constricted," without feeling shortness of breath, and I now know what they mean. My body ached like I never remembered it aching before, a deep bone and muscle ache that just didn't seem to go away -- that ache when you haven't worked out for quite a while and then overdo it at the gym and everything hurts the next morning. Multiplied by 1,000.

Despite knowing that there were issues with NSAIDs, the Tylenol just didn't seem to do much, so at a few points I turned to Aleve out of desperation. Very quickly I lost my sense of taste and smell, but that didn't matter since I had no appetite at all and didn't eat anything for those first three days. I quickly lost about 10 pounds, which certainly wasn't a bad thing since I've been trying to lose some of the extra weight, but this was not the type of diet I would ever recommend to anybody.

I tried to keep hydrated, mixing some grape juice into seltzer, because I'd obviously heard about acute renal injury from this disease, so my life was basically lying on the couch, coughing, forcing myself to drink, trying to sleep, and walking to the bathroom.

Walking to the bathroom -- never thought that would be such a challenge. Every trip was exhausting, my body aching all over, and when I got back to the couch I felt like I needed to sleep for a week. But sleep just wouldn't come. For the first few days I would drift off occasionally on the couch, but then my brain was buzzing and I couldn't sleep at night. Why, if I'm so tired, can't I sleep?

People have asked me what medicines I took, if I used hydroxychloroquine or azithromycin or zinc or vitamin C. Maybe it's that I wasn't sick enough, and while some of these may have a role in critically ill hospitalized patients, for me this felt like something I should just weather, like a really, really, really horrible flu. Tylenol always gives me headaches (yes, odd), and never seems to do much for my fevers, so I didn't even do much of that.

When my son yelled at me for being my own doctor (as he often does on those rare occasions when I'm sick – he's right), I called a colleague who suggested at the very start of my illness that I try empiric Tamiflu, since maybe this was the flu. This was not the flu. But I took one dose of Tamiflu anyway, and during the brief interludes of sleep I got that night I had incredibly vivid nightmares, so I tossed the rest of that prescription. After those first few horrible days, I started to feel a little better, and at least was able to sit up on the couch and watch a little TV.

People also have asked about whether I was tested. As I mentioned, I came down with symptoms on a Tuesday. On Saturday of that week, I went into my office, where I was tested; the test came back the next morning and it was positive. Once I felt better and was cleared by our Workforce Health and Safety Office -- having met their requirement of waiting at least 7 days after symptoms started AND being afebrile for 3 days -- I was chomping at the bit to go back to work. (The office doesn't currently require a negative test in order to return.)

The Slow Return

I decided I was ready to go back, and got up in the morning just to see how things were. I went for a socially-distanced masked walk outside with my wife and daughter, and noticed I was lagging behind them a little farther than usual. When they went up a steep hill in our neighborhood, I was way back, and checked my pulse and O₂ sat. My exertional saturation was jumping around between 86% and 90%, clearly not too good. At that point I decided I was maybe not really ready to go back to work.

I spent the next 4 days just slowly recovering at home, getting my appetite back a bit, although my sense of smell and sense of taste had not returned, so everything still tasted pretty much the same. At one point I was helping my daughter while she made dinner and she asked me to open up a new jar of chopped garlic. Immediately, from across the kitchen, she commented how strong the smell was, whereas I was convinced that it must have gone bad since there was no garlic smell at all to me.

My wife will tell you that she definitely had a milder form of the disease than I did, and while for her a few days were pretty bad, she definitely bounced back quicker than I did.

Our daughter, who has been living with us since her college abruptly closed its campus, while doing her best to keep away from us and use her own bathroom and towels and cooking implements, at one point came out of her bedroom and said, "I don't feel well." But what she had, one day of sniffles, congestion, and sore throat, was what we hoped was the healthy 21-year-old version of COVID-19, although we won't know for sure until we get an antibody test.

Over the weekend before I came back to work, I started doing video visits, and my patients all commented on the fact that I seemed to have two week's growth of beard in the video image, and they surely weren't used to seeing me in a T-shirt in my home. The staff at our practice and my colleagues were incredibly supportive and took amazing care of our practice while I was gone, and my patients got amazing care as well, but I was happy to be back.

As I said before, I feel blessed that I didn't need to be admitted, that I didn't need to be intubated, that I didn't suffer any of the horrible complications, and I consider myself lucky that I'm out the other end, that although it was horrible, I know it could've been much, much worse.

I'm still pretty tired, and my walk home from work leaves me pretty wiped out, and I'm ready to lie back on the couch at the end of the day. I'm starting to sleep a little better, but I still have quite a bit of exertional dyspnea, and what we're all calling the "COVID cough."

Back at work, we're all COVID-19, all the time, manning the cough, cold, and fever clinic, and just this week we opened a tent in a courtyard outside the hospital, where we are doing nasal swabs on employees who are symptomatic. It's amazing and terrifying seeing the decimation of our team members, as social worker after nurse after physician after registrar after manager after custodian come in with all of the protean symptoms of this vicious disease, the fear in their eyes, the hope that they are going to be okay.

We're glad that we're able to provide the services to take care of our patients and our community. And I'm certainly glad to be out the other end, alive and all in one piece.

Stay safe, stay healthy, and stay home.

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