Initially “That Disease” had no name, then we called it atypical pneumonia. The rest of the world would later name it severe acute respiratory syndrome, or SARS.
I am a 23-year-old medical student doing my last year of internship in a medical centre in Guangzhou. I will graduate in 6 months and am well on the way to becoming a medical doctor. My perception of life seemed to have changed on January 26, 2003. We admitted a patient with severe pneumonia to bed #31. His high fever would not respond to antibiotics or any other treatments that we tried. On January 31, we decided to transfer the patient to the Number II affiliated hospital that specialises in infectious diseases. That day I was on call. After making the morning rounds, the chief attending on the ward asked me to accompany the patient in the ambulance because of his compromised respiratory function.
In the ambulance, he coughed fiercely and unrelentingly. Each time he coughed up thick sputum tinged with fresh blood which he then spat onto a piece of tissue paper. After each bout of coughing I quickly repositioned his oxygen mask. It was only a 20-min ride, but at the journey's end there was blood-stained tissue paper all over the floor of the ambulance. The next day the ambulance driver began feeling feverish, he died 10 days later. I was told that the driver had cleaned the ambulance himself with his bare hands by picking up all the tissue paper from the floor. I don't know why I did not remind him of the danger of the tissue paper.
February 1 through February 7 is the Spring Festival (Chinese New Year) holiday and I was on call during this period. In the afternoon of February 2, I returned to the ward to complete a few medical charts. It was cool that day and I already had an additional sweater on, but still I began feeling a chill that seemed to come from the core of my body. It was very uncomfortable, and I decided to return to my dormitory room. While reading at my desk with a blanket on I began shivering.
“I must be getting a fever” I thought to myself “I'd better go to bed.” I could hardly walk the short distance between the desk and my bed. For the rest of the day, I wrapped myself in my quilt and stayed in bed. I got up only twice to go and pass loose stool. Other than calling in sick to the ward, I told no one about my illness. I heard my roommate come in, stay briefly and leave.
On the morning of February 3, I went to the Emergency Room (ER). They gave me some acetaminophen and sent me back to the dorm. My fever subsided only briefly after taking the acetaminophen. I returned to the ER in the afternoon when my temperature reached 39°C. This time they gave me some antibiotics and then sent me home again. In the end, I stayed in my bed for another two days with fever. I did not contact anyone and no one contacted me. I couldn't help thinking about the two patients with very severe pneumonia we admitted last month. One was successfully treated, but the other died. We all knew that the one transferred from a rural district north of Guangzhou had infected nine hospital staff before his transfer to our hospital, but we hardly talked about it.
On February 5, I began to cough. This was my fourth day of fever and I finally accepted the possibility that I might have acquired “That Disease”.
I entered the chief attending's office, “I think I got that disease.”
“Then you must be admitted.” He spoke without any expression on his face, as if he had anticipated that this would happen. Later I learned that he himself was feverish, and that several professors, residents, and one other medical student had already been admitted to the hospital with the same symptoms.
I was allocated to bed #31, the bed previously occupied by the patient I had accompanied in the ambulance. I objected to this decision in vain, for it was the only bed left on the ward. “That Disease” was so contagious in nature that the previous patient in bed #31 not only infected doctors and nurses, but also infected the patient in bed #30. I tried hard to avoid thinking about death, but the possibility of dying in this bed alone occurred to me.
My chest X-ray showed some small questionable shadows bilaterally on admission. I continued to run a fever, and the cough persisted. Any external stimulus would trigger a bout of coughing that would last for minutes. The chief attending came to see me at some point. “You'll be OK. Your chest X-ray remains unchanged.” I knew he had lied to me, though I could appreciate his intention to comfort me.
On the 7th day, I began to cough up blood-tinged sputum. Soon I started keeping my breathing shallow. Taking deep breaths brought about a very unfamiliar type of discomfort. It felt like my chest was expanding in an uncoordinated manner giving me a sense of impending suffocation. Gradually, each one of my heartbeats was associated with chest pain. It finally got to the point that any small bodily movement would leave me short of breath. My body was very weak, but my mind was absolutely clear. I consciously kept still at all times, I knew I must put all I had to take each breath and to live every minute of my life until my own immunity takes charge of the situation.
On the 10th day I heard that the chief attending said that they would transfer a few severe patients to the Institute of Respiratory Diseases (IRD)—where the doctors were specialists in treating patients in critical respiratory distress. “I hope that I am one of them.” I made a wish.
By now I was very weak, but during the transfer to IRD I noticed several of my colleagues, all of them in layers of gowns, gloves and masks. The head of the IRD came to see me. In a low and calm voice he said “We'll take care of you. Don't you worry.” At that moment I sensed I was going to pull through.
I had decided to phone my mother on the fifth day of my illness when I was first admitted. “I might be dying. Don't you be too sad. You know, this comes with being a doctor.” I heard her crying at the other end of the phone. I could imagine that afterwards she began to search for someway to come to Guangzhou. She would not think of taking a flight for she had never taken a flight in her life. Trying to get a train ticket at this time of year would be like fighting a war, for tens of thousands of out-of-town workers would be returning to Guangzhou at the end of the New Year's festivities. She finally arrived in Guangzhou on the 12th February—the second day of my transfer to IRD.
“You must be strong.” She whispered. Gowned and masked, she wept quietly at my bedside.
While recovering I sometimes reflect on the disappearing nursing aides. They are hired to attend patients at the hospital bedside 24 hours a day for a small fee. They are workers of all ages and are from all parts of poor rural areas in China. During the time when “That Disease” was most rampant in the city they were infected just like many doctors and nurses. They disappeared from the hospital site as soon as they got sick, for they could no longer work, nor could they afford the enormous medical fees.
The following three weeks of my life were a blur. My survival was intimately linked to Continuous Positive Airway Pressure (CPAP), glucocorticoids, my mother's tender loving care, my own will to live, and my confidence in the doctors and nurses taking care of me.
After discharge from the hospital and a further two weeks of recuperating in isolation, I returned to the internal medicine ward, making rounds and seeing patients as before.
“It's great to be alive.”
Author's note
At the time of this interview reported cases of SARS were increasing in number and spreading across China. The nursing aides would return to their hometowns and blend in with the 800 million farmers in the vast rural areas of China, carrying with them the SARS virus from Guangdong.
I would like to acknowledge the assistance of Dr. Barbatunde in shortening this paper for publication.