It Took One Person, And One Errand, To Infect My Entire Family With COVID-19
I wake up to a flash of flashing lights that are blue and blink against the darkness of my bedroom. Numbers. My body feels heavier than normal, like I have a weighted blanket, but I don't. It's on the couch in the living room. The base of my skull hurts. My lower back too. 88, 88, 88. It doesn't change. This number makes sense. I know it. Oh yeah. It's the year I graduated from high school. When I orient myself now, I notice that it is also the number that flashes on my trustworthy pulse oximeter. Alarmed, I force myself to sit up.
Damn it! "The doctor told me to sleep on my stomach, but I keep waking up on my back."
Courtesy of Alix Atwell
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My body was trained to sleep again. I have been using a cervical traction cushion for 10 years. It was a stroke of luck. I'm a nurse. I had a herniated disc years ago when I manipulated the equipment and my tired body worked a double shift. I started my career as a nurse in the emergency room and in the intensive care unit, but switched to work and childbirth a few years later. After lifting and moving patients day after day, I was sure that something would give. It did. My neck snapped or cracked or moved. An MRI would prove all three. My body screamed "enough".
Was it the same silent cry that just woke me up? "Enough!" "Enough sleep." "88 is too low!" "Wake up and die alive!" My late mother used to tell me about this phase when I watched TV too much or slept late into a Sunday afternoon, as teenagers should. "Wake up and die alive." Has she taken care of me now? Did she wake me up?
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"But mom. I am not dying. I was at the doctor. I am not even sick enough to be hospitalized. My pulmonologist gave me dexamethasone and azithromycin only yesterday. He ordered oxygen home and told me to sleep on my stomach. I'm not even sick enough for my insurance to approve the same day's oxygen supply. I am even healthy enough to write these diatribs at 2:43 a.m. It is actually fear that keeps me awake. But shhh ... don't tell anyone. At least writing will distract me from my thoughts. "
So I sit up, support pillows, which in turn lower my oxygen content to a healthy 97%, and breathe deeply and deliberately. My headache subsides. My back pain subsides. I lean forward, grab my computer, and write for the first time in three long months.
* * *
It's in me First it penetrated my husband, then my two children. Now me. That seems to be the rules of procedure in my house. It is as if my body decides that it cannot get sick until the others are on the mend. In 2017 it was influenza A. My husband brought it as a souvenir on one of his many work trips to Japan. In 2018 we got influenza B. "Are you serious? We all have flu shots! “Now it's SARS coV-2 (also known as COVID-19).
This time the fateful souvenir came from a trip to the gas station and home depot. My husband hadn't been away for weeks. Since the beginning of the quarantine, I had insisted on being the only one to get food and supplies. Finally, as a 27-year-old nurse, I knew about sterile technology. He replied, "You are paranoid and controlling" - traits that I openly admit. I got it from my mother. "You forget. I worked in a genetics laboratory. I also know about sterile technology." He was right. He was smart. He was a trained scientist who was now working in biotechnology. He probably knew the germ theory better than I did He put on his mask, armed himself with Purell and went out. It was so long ago that he had left the house or done something normal. He itched after a scene change. Who could blame him?
It was May 1st in Illinois and everything was blooming. My husband had developed bad allergies since we moved from California three years ago. That evening I remember his eyes. Wow, your eyes are really bloodshot and swollen. Your eyelids are so swollen. Do they hurt? "Damn allergies," he said. Where are my drops, Hun? "" See, you should have let me go instead. " I grinned when I handed it to him.
I am an armchair epidemiologist. In high school, I had dreams of working with Anthony Fauci at the CDC. My mother graduated in biology and wrote a paper on a new creepy retrovirus called HIV. I was hooked. I later occupied myself reading about outbreaks of Ebola and Dengue, SARS and MERS while eating popcorn and sipping juice boxes next to my two children while playing with blocks and seeing Super Why and Caillou. When news of a novel virus broke out in China in early January 2020, I devoured every article I could. This was the one we were waiting for.
Courtesy of Alix Atwell
The closure was not a surprise to me. I took the initiative and canceled our spring trip to California, although a dear old friend had planned my 50th birthday party, which 40 of my dearest friends and family members should attend. This was weeks before the government "cautiously" advised against non-essential trips. Friends thought I was an alarmist! Some are still doing it.
I quarantined 50 a week. Everyone was still adapting. Nobody had their deeds together yet. There was no auto parade or zoo party for my COVID birthday. I switched to middle age with little fanfare. The only card I received in the mail was my AARP card. Oddly enough, that was the last month I menstruated. (I know, TMI.) It seems that my current stress tolerance has finally reached a turning point that has led me into the menopause. It wasn't long before the composite COVID -19 pounds and lack of my bi-monthly dye job made me part of the middle age. Now, months in isolation, with 88 blinks, I feel the role too.
88 is a threatening number for those of us in the medical field. With a pulse ox. of 92% I would give my patient a nasal cannula (low flow oxygen). At 88% I would choose a face mask without a rebreather (high flow oxygen) instead, as they could suffer permanent organ damage with such a low oxygen level. I know that medical practices are changing quickly and that I was trained in the old school. Things that used to be routine, like bed baths and enemas and now even holding hands, are now a thing of the past. I can roll with change, but I honestly didn't anticipate that a day would come when a sudden 88% oxygen saturation would buy you an oxygen machine at home rather than a hospital bed. We entered postmodern COVID times. The old rules no longer apply.
To be honest, I'm scared. But I can't show it. I have an 11 year old daughter who cried yesterday when I went to the doctor's appointment. When I packed my car keys and bag, my dogs seemed worried too. I had packed a small bag and thought 88 could be the magic number that would buy me a stay in hospital. "Mom, you have to come home. I can't go through what I went through with dad. I can not. It was too difficult. "
It has been a difficult month for all of us, but my daughter in particular is struggling hardest. She hasn't gotten used to sequestration, home school, or the need to get a cold turkey because of a fairly severe addiction to Chipotle. My 14 year old son, on the other hand, thrives. "I'm introverted, mom. I was built for it!" He retires to his bunk bed, where he now controls his fate in Minecraft Dungeons, Stardew Valley and the bond of Isaac. He has asked for it since grade 3 To be taught at home, he finally got his wish!
Things changed dramatically for us when her father suddenly fell ill with flu-like symptoms on May 4th. (May 4th is yours!) We have taken the right precautions. He was banished to the guest room for days. While he was sweating alone, my two children tried to navigate through the news and their emotions between the zoom meetings in the classroom. You missed a few. Who shits!
I was concerned with sterilizing door handles, facet fastenings, worktops and everything else in sight. My son came out of hiding a little more often to hug and eat and clung to the dogs like a toddler is making his blanket. My daughter worked on sewing two-layer cotton masks for important local workers and baking unusual treats such as coffee cakes and macaroons. She learned homemade frappuccinos (vanilla, strawberry, matcha) and whipped coffee frappés. The strawberries are a dream.
Courtesy of Alix Atwell
My husband's symptoms were strange and suddenly disappeared 4 days later. After a negative smear from the nose to the brain and no airway involvement, the doctors insisted that he was safe. He couldn't have had it, but even if he had, he wasn't contagious as long as he was symptom-free and 7 days before the symptoms appeared. So he came back to us on the eighth day. The dogs, the children and the short-term cook (I) were so happy. But the advice was wrong.
My husband crashed two weeks before the day of his first symptom. It was a monday. He was working from home on his cool new suction stand, drinking coffee and feeling good at 10 a.m. He came into the kitchen, where I taught the kids at 10:30 a.m. and said his legs felt weird. "Darling, I don't feel quite right. I have a feeling that my knees will give way under me. I'll lie down a bit." Less than an hour later his lips were blue, his face blotchy, his hands and feet cold and yellow like a day old dead. He was tough (nurses speaking for violent and uncontrollable shaking - basically increased shivers - and is the telltale sign of full-blown sepsis, which is far more threatening than 88% oxygen saturation).
But was its temperature normal? So was his mention? First hornets, now a zombie apocalypse? My brain couldn't calculate what I saw. When I found my phone and reached the doctor, his fever was 103.1. We grabbed his phone, charger, keys, and some homemade masks and drove the two miles to deposit him on the doorstep of the local hospital. Like a desperate mother who dumps a newborn who loves her very much but is poorly equipped, I went and waited soberly for the word.
My husband was in the emergency room for 6 hours before they admitted him. They ran a number of tests and laboratories. He sent me random texts and photos from his monitor between the lab drawings, his EKG, and was taken to the cat scan, X-ray, and his nap. Before he was transferred, a very friendly nurse informed me of his status and laboratory results. His numbers were really wrong. D-Dimer, 15. Ferritin, 1681. PCT 16. C-reactive protein 10.8. Magnesium 1.4. LDH, 439th AST, 445th AST, 314th Lymphocyte 3%. She read it out in an expressionless voice, but I had worked in the emergency room and in the intensive care unit. The numbers she reported were WACK. He was really sick. FUCK. She informed me that they were sending a nose swab for COVID, giving him ibuprofen, oral antibiotics and IV magnesium, and sending him to a COVID unit "just in case". Since he had no respiratory symptoms and an elevated PCT, which usually indicates a bacterial infection, this was unlikely.
It was a long night. I called the night nurse shortly before changing shifts to get an update. She said my husband's blood pressure was very low and she contacted the doctor on call for instructions. Not long after, the night shift nurse called, who was on call when he was admitted and was finishing her shift. "His blood pressure dropped to a dangerously low 60/40, but was now at 80/60 with half a liter of fluid." (If 88 vs. 92 is the difference between an oxygen mask or a nasal cannula, a blood pressure of 60/40 vs. 80/60 is the difference between a medical and surgical bed or an intensive care bed. He hasn't pumped enough blood to keep his organs alive to get!) I panicked.
I knew from my experience that septic patients whose blood pressure drops dangerously low require several liters of fluid to perfuse their organs, which is not equivalent to two cups of water. I started screaming and crying on the phone. Not my best moment.
"Oh my god, he's going to die. Do something!" She calmly stated that they could no longer give him because COVID patients tend to transfer fluid to their lungs, and this could result in the need for a ventilator. She continued. “Oddly enough, COVID patients tolerate low blood pressure and low oxygen saturation very well. She assured me that he was completely awake, spoke clearly and actually felt fine. We act carefully for a reason. We got him. He'll be fine. "I was scared but calm. I thanked her and hung up.
After that, the communication got blotchy at best. The day shift nurse didn't return my calls two days in a row. Andy called between breaks, but he was sick and tired. I didn't want to scare him with questions. He would have no answers anyway and questions would only fuel his fear. He was so brave. Like many men, he is usually not a stoic patient and does not do well in hospitals. He almost passed out when I cut my finger and needed sutures on his 35th birthday. He was a comforting catatonic during the bloody delivery of our first child.
I gave him what he needed, a loving woman and a good cheerleader. But there was no one to give me what I needed. Information. Communication. Reassurance.
It was only when a friend of a doctor kindly offered to make a few calls and examine some things that I was put on the communication loop and got laboratory readings and test results. I was late Wednesday now. The hospital doctor for infectious diseases of this suburban hospital in Chicagoland had diagnosed him with typhoid fever. TYPHUS? Why? Because he had a negative COVID nose swab (I mentioned that he had no difficulty breathing) and had diarrhea and high fever. He had seen it a hundred times. He was trained abroad.
But he hadn't called me to get a detailed history of my husband's current illness. He didn't notice the complete absence of any GI symptoms until antibiotics were used, and he wasn't thrilled when I informed him about my husband's swollen eyes three days before the symptoms started, even after I faxed him a Lancet article in which up to 50% of JVA cytokine storm patients were indicated have no respiratory symptoms. A JAMA article cites unusual but statistically significant cases of COVID-19 patients who get eye transmission with negative nasal swabs and elevated PCTs, and how increased PCT levels are directly related to severe COVID brought -19 infections. (I was busy while waiting for a word at home.)
As a nurse, I am very concerned about the level of hospital care in the period of COVID. I know it's an extremely challenging time for everyone, but we have to do better. My husband was too sick to tell a full story. Allowed without a family at the bedside or included in the admission, also by telephone, compromised hospital patients have no voice and no lawyer during the period of COVID.
This affects care and can lead to misdiagnosis and inappropriate treatment.
Dr. Typhoid put him on several broad-spectrum IV antibiotics that only worsened the diarrhea caused by my husband's hospital. The dogged doctor then reduced the blood thinner he was put on, which would save his life if it were COVID. Fortunately, the night shift hospital doctor, the nurse who had assured me days before that "she had him" noticed the change that evening, corrected it immediately, and insisted on statistical scans at midnight to make sure there were none Had clots in his legs or lungs during sub-therapeutic dosing. She called me to get approval and let me know she was there! But what does that say about a hospital if the doctors don't agree on the diagnosis or the treatment plan?
Miraculously, my husband's laboratories normalized on Thursday and his fever had dropped. He could even attend Zoom's 8th grade son's graduation party! All cultures were also negative, so I requested a COVID IGM and IGG before being released. I thought without a positive culture there would still be no definitive diagnosis. With great reluctance, Dr. The IGG's typhoid, however, said the hospital was unable to perform an IGM.
IGG shows an immune system that has recovered from an infection. It takes over 2 weeks for the body to fight an illness to produce it. The IGM first appears in the earlier stages of fighting a disease - it appears about a week after the fight begins. At this point, a person can still transmit the disease to others. His COVID IGG came back negative.
Courtesy of Alix Atwell
They sent him home on Friday to recover. His discharge diagnosis in his table was "Typhoid Sepsis - NOT COVID". They sent him home with instructions on how to prepare food. Dr. Typhoid insisted that even if it is COVID, patients are not contagious if they are fever-free and are 7 days before symptoms first appear. Therefore no insulation was required.
I know this is the current line of business, but this conclusion doesn't suit me well. I don't see the data to back it up. I trusted Dr. Typhoid's advice and our personal history, as my husband's symptoms returned so suddenly and profoundly in over 14 days. This seemed to prove the opposite. I really wanted my husband to be home and safe, but I didn't want to risk infecting myself and my children. We were still asymptomatic. Or were we?
Just a few hours before I wanted to pick up my husband, my son's nose turned. Like a tap! In two hours he went through two full handkerchiefs. There was snot everywhere! His eyes went glassy. I took his temperature, 99.7. "Mom, my stomach hurts too." Ugg! What do I do now? I could seize him and my husband in the back room, but my husband needed his rest. He would be too sick to take care of my son alone. Would I be able to take care of her without contaminating my daughter without PSA? And in reality the cat was probably out of his pocket. If my son had symptoms now, my daughter and I would have been exposed. You and I have affected the lungs. That was not good. With great reluctance, I decided that the only practical way to do it was to ride the wave together. Sometimes practical logic sucks. At least we would all have each other.
Courtesy of Alix Atwell
Where was I? Oh yes, Friday May 22nd. My youngest sister's birthday, my husband's discharge day at the hospital, and the start of my pediatric rotation.
The next few weeks consisted of TID temperature tests (that's three times a day for people outside the hospital) and nightly pulse oximeter tests. A neighbor was kind enough to lend me her replacement when Andy first fell ill. The stores were out and Amazon was made to order. No day passed in the next two weeks when one or the other child had no time. Just under 100, not high enough to call the doctor, but not low enough to breathe easy. One child had a severe headache one day, the other woke up with diarrhea and nausea the next. Both acted in their typical sick style. My son, unusually cuddly, my daughter Ornery as a tired old mule. In the meantime, I cleaned, cooked, worried, mowed, ordered from Instacart, worried, and went with my husband through the neighborhood to build up his lost stamina.
I mowed the lawn a week ago, 20 days after my husband's discharge from the hospital and my children's first symptoms. I started to cough when I went to bed. Coughing after mowing is not uncommon for me. I have bad lungs from a sick building I used to work in. They are sensitive to vapors. But after that my lungs felt like they were on fire. It was strange. I grabbed the pulse ox. 89! "That can't be right? Can it?" I sat up and took a few deep breaths and it jumped to 97. "That's more like that," I thought. I poured myself a finger of bar whine, a delicious honey schnapps that every medicine cabinet needs, sipped it to relieve my cough, and went to sleep.
The next day I felt good. The children were finally free from fever. Andy was working on his standing desk again. It was beautiful, sunny and warm with low humidity. I decided to take advantage of that. I trimmed the hedges, took some nature photos and cut some flowers from my garden. Later that day, I celebrated a niece's graduation from Facetime. YAY! We were back to normal in the pandemic! But the same thing happened that night. A burning cough and an ox with a low pulse. This time I kept going. It stayed low when I was lying on my back, but it was normal when I turned or sat up.
I spent the weekend in denial. "I'm not getting sick. I'm not getting sick." I made pancakes. I did laundry. I accompanied my husband on his daily recreational walks, but when he refused to take the hilly road to the right, I did not push him this time. I already felt agitated. I attended another niece's graduation from college - go banana slugs! But now I sipped barenjager in the afternoon to hide my annoying dry cough from my Zoom family. My energy was good. I didn't have a fever, but my lower back and legs ached. Maybe it was just gardening. Sunday night I got an oxygen level of 83. Now I was scared.
I spent Monday morning calling local emergency centers to see who could do COVID testing, X-rays, and laboratories. I called my family doctor and pulmonologist and was directed to messaging systems where I could send symptoms via SMS and set up virtual meetings. COVID needed to finally bring healthcare to the digital age! It was late afternoon before I spoke to a living body, but gratefully I made an appointment for the next morning with my pulmonologist, who could see COVID patients, make the dreaded nasal swab, and take an X-ray. I was short of breath at the time when I climbed the stairs and got a little tired of doing chores. A mild but present pressure and a tightness in my chest accompanied me wherever I went. I looked impatiently at a blinking 90 and waited for morning to come.
I had an early morning appointment. I arrived early and called from the car so they could get dressed as directed. "Enter through the side door, the one with the big pink COVID warning on it." Within minutes of my arrival, my vital signs, chest X-ray, and nose swab were done. It really wasn't that bad and was over in a second. Why do people make so much of it?
My doctor was fantastic. As a Chicagoland pulmonologist, he was now far more familiar with the disease process than he would like to be. Fortunately, his PSA, his diligence and his current knowledge have made him disease-free so far. He stood in full robe, his hand on the door more than a meter away, and told me straight away. You have COVID. Regardless of whether the test is positive or negative, you have COVID. You will feel worse before you feel better. You will not feel like you for at least 2 months, if not longer. You are contagious From what I see, your family could give off viruses if they live with you, even if they have no symptoms and have recovered from them. He prescribed medication and oxygen and gave me instructions. But he went ahead of them. “These are just supportive measures. We have no treatment. And you're the healthiest COVID patient I've seen here so far. This is probably because you are here at the beginning of your course. So be careful and call or send an SMS with questions or changes. And with that I was sent home. "
Courtesy of Alix Atwell
That was yesterday. My headache is gone now and my oxygen flashes reassuringly at 97. I won't sleep soundly until I get my oxygen tank ... but by then the steroids are likely to have occurred. Oh well. My doctor warned of the fun that comes with it! But I'm thankful. I'm home. I have a plan. I am the last person to get sick in the house so that my illness can keep me company. I have the tools to monitor myself and the medication to help my body heal. I have no idea what tomorrow will bring. The only certainty at the moment, other than the upcoming sunrise that I will experience, is that I am not going to Dr. Typhoid will decide if I need more services.
It turns out that the delay in oxygenation at home is due to the fact that COVID is not currently a qualified illness for insurance. I had to pay out of pocket to get it, but even that required the approval of senior management. It appears that home oxygen requires a chronic condition such as COPD or heart failure. Home management is best suited for non-critical cases of COVID. It saves urgently needed hospital resources, reduces costs to a minimum and ensures more security in healthcare. COVID is currently not considered a chronic illness. However, many people suffer from debilitating symptoms for months. They even have a name. Long-distance driver.
The day after I wrote that, my daughter fell back. She had a high fever, chills, weakness, uncontrolled tremors, a fast heart rate and said: "The air feels thin!" She needed an emergency exam because our local pediatric practice follows a policy of not seeing COVID patients. I wasn't allowed to take it because I had symptoms. My husband was a rock star! Her symptoms disappeared as soon as they came. Lurie's experts assured us that children cope with the waves of COVID symptoms far better than adults, and she was sure to drive them at home for now. The next day my husband's symptoms returned. Fever, chills, body aches and malaise. You are now a long-distance driver.
Courtesy of Alix Atwell
Seven days after completing my test, my doctor called with my COVID swab result. Positive. The validation leaves a bitter taste in my mouth. If my husband had received proper tests and safer instructions. My children and I may have been spared. We relax side by side, me with my oxygen and my steroids, my daughter with her breathing treatments and Tylenol. My husband is pushing between symptoms from home. My dear son helps around the house, takes care of the dogs and even made us cupcakes.
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