To the Editor:
I am COVID-positive. It feels strange to even type these words out. It feels like a Scarlet letter stamped on my chest. I feel like a statistic, having been glued to Cable News Network (CNN) for the last many weeks watching the numbers of cases in the US and especially in New York tick upward at a frightening pace. As of Saturday April 4th at the time of this writing, there were 13,346 cases in my county of Nassau County, New York. I am one of those cases. I am a Consultation-Liaison psychiatrist in a New York hospital and also the director for our Consultation-Liaison fellowship. While the majority of psychiatrists across the country work in outpatient locations treating patients on a weekly or monthly appointment basis, my work typically required more urgent interventions, which would be compressed into a few days' time or perhaps across a few weeks, until the acute psychiatric issue had been solved and the patient got discharged from the hospital. I love my job. I loved walking around the hospital and interacting with the medical and surgical physicians; they were my colleagues and also my friends. The hospital, despite it housing many sick patients, was always a joyful place. There was always an air of collaboration and hope. But by mid-March, this feeling changed. There was a palpable feeling of dread in the air; at first, it was mild, but then as the last few weeks progressed and each and every hospital worker donned a mask, it felt like a place I desperately wanted to flee from. My own team of five psychiatrists began developing protocols of how to consult on any COVID-positive patients or patients who were deemed a “COVID rule-out.” To preserve both personal protective equipment (PPE) and our own health, we requested the assistance of medical teams and nursing and ancillary staff to allow us to communicate with our patients using an electronic device – any device – whether it was the patient's own iPhone, the nurse's iPhone, an iPad, or just the regular phone in the patient's room. While this arrangement didn't work for all patients, especially ones who didn’t speak English or displayed agitation or confusion, by the time the week of March 23rd arrived, I was definitely spending a lot more time in my office and less time out on the medical floors. Numerous times per day, more than I could count, I would hear the words “anesthesia stat,” “medical rapid response” or “code blue” echo over the hospital loudspeaker. My team, with myself included, was growing more anxious with each passing day. We had finally managed to secure N95 masks, then eventually face shields. These would surely protect us. Right? Right. I made sure to take time out during my work at various times in the day to take a few deep breaths. Inhale … Wait … exhale. Inhale … Wait … exhale. It's ok, I got this. I can control my breathing. It will all be ok. Inhale … Wait … Ok, exhale. I would repeat this breathing cycle for at least ten times and then return to my hospital work.
My symptoms began over that same week; I think it was Wednesday March 25th, but it could have been on Tuesday March 24th. I began to notice that I was having difficulty getting deep breaths in fully. And a tightness appeared right in the middle of my chest. I felt shortness of breath come on at random times during the day. I would stop and try to do my deep breathing. Sometimes I was able to, and other times it felt like I just couldn't get in a good satisfying deep breath. That night, I told my husband what I was feeling. He said “it's probably anxiety. Everyone is anxious and stressed right now.” He's right, I thought. It's anxiety. But I've had anxiety in the past, especially when it peaked during my medical school years. I've been very stable for the last 15 years, but I still vividly remember what that anxiety felt like. This current feeling I was experiencing was … different. Suddenly the deep breaths that were able to give me solace during this time of crisis were now no longer certain. I felt a sense of control slowly slip away. The next two days, Thursday March 26th and Friday March 27th, the feeling of not being able to get in a good deep breath intensified. I had to force myself to yawn, which strangely would allow me to get in a deep breath (most of the time), and I would feel ok for a few minutes. But then the cycle would start again, and I would need to force a yawn. Could this be COVID? I was sure no. I had no fever, no cough. I had been beyond careful at the hospital. I am not on the front lines. I finished out that week of work and decided to see how I felt over the next few days, especially as the coming week I was scheduled to work from home. Maybe I just needed time away from the hospital. The urge to yawn subsided a bit over the weekend and into Monday – but the tightness in my chest was still there, and the shortness of breath was there. I decided to get tested. I was finally able to get an appointment at a local urgent care clinic for Tuesday the following day; but when I woke up that morning, I received a message that the clinic site had been closed for the day and I needed to make a new appointment. Uggh. I got an appointment for Wednesday April 1st, and luckily all went well, and I received my test. Only my husband knew where I went that morning, and when I returned to the house afterwards, I simply said to him “it's done.” My kids didn't need to know anything about this. They are probably already more frightened about this virus than they let on.
I downloaded a breathing app called “Deep Calm” where you pair your inhales and exhales with a growing and shrinking lotus flower. It helped. The need to yawn felt less. Ok, I'm pretty sure this is anxiety. Definitely anxiety. But … just maybe it’s COVID. I got my test results on Friday April 3rd. Over the phone they confirmed my date of birth and then said “You tested positive for COVID-19.” I felt a gulp in my throat. Really?? Wow. My first emotion was relief – I knew something was different in my body. Deep down I knew it wasn't just anxiety. My next emotion was dread. Over the past week, I have already exposed my entire family to this virus. Done. Over. Nothing can be done to reverse that. Next came the thoughts “Why me? How did I get it? I was so careful.” My thoughts went to a patient I had first seen on March 17th who had been admitted for altered mental status and lethargy. I had been consulted for possible catatonia and during my exam I did a physical examination to test for various signs including stiffness, catalepsy and waxy flexibility. On March 20th, I saw the patient again in follow-up. Later that same day, the infectious disease team was consulted and recommended a COVID test even though they had a low suspicion for the patient having the virus. On March 21st, the patient's results came back that she was COVID-positive. I reached back in my memory – was I wearing a mask during that encounter? I'm pretty sure. But was it an N95 mask? I'm not certain. I think that was before our team got our batch of N95 masks given to us. I touched the patient, but definitely with gloves on. She never coughed or sneezed on me, but I was close to her face. So maybe I got it from her. Or maybe I got it from another patient without any symptoms. Or maybe I got it from the grocery store in my town. Or maybe from my husband, also a physician (an anesthesiologist) who never showed any symptoms. I'll never know. All of a sudden, I felt like the virus must just be everywhere. If I got it and I'm not even on the front lines in an emergency department or an intensive care unit, then how do those front-line health care workers even stand a chance.
I didn't tell my sons that I have the virus, I simply said I was feeling a little sick, so I have to stay away from them a bit now. I want to hug them now more than anything. My 10-year-old son, however, figured it out. He said to me yesterday “You tested positive right?” I guess he overheard a phone conversation I had. But then he said “but you don't have the virus right? Not everyone who tests positive has the virus right?” I told him with some hesitation “Yes … I do. Everyone who tests positive, it means they have the virus. But I am really lucky to have a mild case so far. We just have to hope it stays like that.” We all just coexist now in the house, as one unit. My husband, myself, our three sons, our live-in au pair, and our dog. We are now a “COVID household.” When the Department of Health in Nassau County called my house a few days ago after receiving my test results, she said “Ok, now you are all under quarantine, for the next seven days. Your kids can't go out. They can go in your backyard, and that's it.” So now by extension, we all have a Scarlet letter on us. But the irony is, my husband will continue to go to work at his hospital. At the current time, he has no symptoms – but we both assume he has the virus and will exhibit symptoms at some point in the near future. Will he still be able to function normally at his job? Instead of worrying about getting enough PPE to keep from contracting the virus himself, his goal now is to prevent transmission to others – if that goal is even a realistic one. He is on the Obstetrics anesthesia service now, putting epidurals into women in labor. Will some of these women unknowingly contract the virus, and will their infants? These are the questions that leave us so uneasy.
As I enter my next at least seven days in quarantine with my family away from the hospital, I will be looking to my breathing for clues as to if I am getting better. Taking deep breaths multiple times each and every day will be the key to helping my lungs stay as open as possible. I have seen an outpouring of love and support from my friends and family sending me prayers for a speedy recovery. My psychiatrist colleague even dropped off an incentive spirometer to my doorstep in order to help prevent a full-blown pneumonia (although it's possible I have a small bout now). For me, at this point, my deep breaths will serve a dual function: to keep me physically healthy as well as emotionally calm. I am confident that I will come out the other side of this unscathed. I think about others whose lungs cannot manage this type of insult, or who develop severe immune reactions, and aren't as lucky as I am. I take deep breaths daily for those people too. I am certain that very soon, I will again be able to depend on the rhythm of my breathing to help me regain a sense of control. Inhale … Wait … Exhale. Inhale … Wait … Exhale.