When I entered the patient’s room to exam her for the first time, she was coughing. A dry non-productive cough over which she had no control. She was on oxygen via a little tube called a nasal canula which, when removed, caused her oxygen saturation to drop below 90%. She depended upon this supplemental oxygen to function, to move her body, to breathe comfortably. She had finally made it to the rehabilitation hospital after a long, two-month hospitalization fighting for her life due to COVID-19. She was one of the unfortunate patients that had suffered the severest form of this disease; it had affected her lungs, heart, nerves, muscles, skin, and even her brain. She was alive and would never be the same.
In addition to her trouble breathing and incessant coughing, every time she walked more than a few steps, her heart raced to over 120 beats per minute, requiring her to stop every ten feet or so for a break. She rested in bed in between her therapy sessions during the day as she was so debilitated from being in a hospital bed for over sixty days. Weakened to the extreme, she had a hard time lifting her legs both on and off the bed, due to what’s called a “critical illness myopathy,” when the muscles are damaged due to the strong inflammatory response of the body. She felt numbness and tingling in her feet and hands, a known complication of COVID-19 where the peripheral sensory nerves in the limbs are also damaged by this inflammatory storm, as the body tries so hard to fight off the viral infection. She had several black, gangrenous toe tips, which likely started as the red “COVID toes” and progressed to dead tissue due to lack of oxygen. Worst of all, she also had a stroke from COVID-19, in the form of a subarachnoid hemorrhage, caused by inflamed blood vessels on the top of her brain that ruptured and bled. This injury to her brain caused her to have impairments in her thinking, difficulty in her focus and attention, and in her short-term memory, a post COVID-19 “brain fog” that is also common. In short, this virus had transformed her body and her mind into something she didn’t recognize.
After examining her, I explained to her what to expect from the rehabilitation process: very likely several weeks of therapy before she was strong and medically stable enough to go home. She was hopeful that she would get stronger and had goals to return to work, to driving, and to getting off oxygen. I didn’t have the heart to tell her the first time we met that she may not be able to achieve these goals, based upon my experience in taking care of other patients who had survived the most severe symptoms of the disease. She believed that she would go back to “normal,” and I did not discourage her from this belief, as it would motivate her to work hard in therapy. She also confided in me that she never believed COVID-19 was real and that she didn’t wear a mask while working. She wondered if she got it from the people she worked with, who also didn't wear masks. I told her the truth: there is no way to know where she got the infection. It was everywhere in our community, with a positive test rate of over 20%.
The following morning when I saw the patient, she told me that the speech therapist had done her assessment, and she was discouraged to see that the tests showed she had difficulty with her memory, attention, and problem-solving. She asked me if a product that she had seen on the internet would help her regain her memory. I had never heard of the product but told her I would research it. I looked up the supplement and discovered that it was made from sea animal parts and that the Federal Trade Commission charged the company that makes the product with false and deceptive advertising. And last year there was a class-action lawsuit against the company claiming they intentionally misrepresented their supplements as being effective in improving memory. The patient was so disappointed the next day when I told her what I found. She didn’t understand how it couldn’t be true as the internet said it worked. She was looking for a magic pill to cure her cognitive impairments.
I’m at the point in this pandemic that I often don’t know what to say, or how to react to those that don’t believe. Early on I would get irritated and angry, so disappointed that we all couldn’t believe the science and do the right thing. I would have conversations with my patients trying to convince them that no, the SARS-CoV2 wasn’t created in a lab in China, paid for by President Obama, and no, the vaccine does not have microchips in them.
The truth is that you can’t change someone’s belief, because they do not reside in the rational or cognitive part of the brain. Maybe some don’t believe because deep down they are afraid, and by refusing to accept the truth, they protect themselves from the fear. Maybe others do believe COVID-19 is real and is a global pandemic, but they refuse to wear a mask or get the vaccine because it’s inconvenient and makes them uncomfortable.
It’s almost as if, as a species, we are in the stages of grief over this pandemic: denial (it's not real! masks don't work! people are dying from something else!), anger (my loved one is dying, do something! Put your damn mask on! You can't make me wear a mask, it's against my civil rights!), bargaining (what if I just invite a few friends over? If only the CDC did a better job of giving us accurate information early on. If only the government got their act together with vaccine distribution), depression (this is so awful and is never going to end. There's no hope the vaccine will work. The virus will keep mutating), then finally acceptance (the world is suffering from this pandemic, and yet it is a great opportunity for us to come together, problem solve, save as many lives as possible, and prevent something like this from ever happening again).
As for me, I vacillate between shock, anger, depression, hope, and acceptance. I stand at my patient’s bedside without words, I vent to my colleagues when science deniers make their irrational claims, I cry at home at night when my patients die. I also feel hope when a non-believer asks me my opinion regarding the vaccine, when they trust me enough to be open minded. And I accept that I will not be able to change the world, just change the experience of each individual patient I take care of and pray the ripple affect prevails.
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