COVID-19: Had It and Survived
but it was a very close call…
How I Got It
As the summer was coming to an end, we flew to Kaliningrad for a few days to visit my parents and smell the sea for the first time in a year and a half. We took all the precautions, but it must have been at the airport or on the plane — my wife caught the infection. In a few days, she started having some mild fever and complained she couldn’t smell things. Three days later both I and our daughter woke up with fever, and the diagnosis was clear. We didn’t get tested as we didn’t want to get into all the kerfuffle with the mandatory isolation and spying apps on our phones, but we isolated ourselves anyway; I was on my annual leave, so I didn’t need to go to work, and my wife is still on her maternity leave (those can be really long in Russia).
My wife got better very soon, her sense of smell returned in a couple of days (I also had two or three days when I couldn’t smell things), and by the end of the week, she was feeling well again. I had high fever (close to 40°C, sometimes even over that mark), but I wasn’t worried too much: high fever is how I usually react to respiratory infection. When I catch a cold, it’s usually two or three days at about 39°C, and then I’m back to normal. I was much more worried about our daughter; after all, she was only just about to turn 6 months old…
Luckily, the daughter started getting better soon. I didn’t.
Let’s be frank: I’m privileged in several ways, and it affected the consequent events to quite some extent.
First, I live in Moscow. Living in Moscow has its downsides, but it gives access to some of the best services in Russia, including medical services. Russia is very centralized, which is, I think, not a particularly good thing in general, but convenient if you live in the capital. In medicine, if something is possible in Russia, it is possible in Moscow. If a procedure can only be done in one hospital in Russia, that hospital would be in Moscow. Had I lived in a little town somewhere in Siberia, my chances of survival would be much closer to zero.
Second, we are a medical family. Both my parents are doctors, my wife comes from a medical family, too. Both I and my wife are doctors, both of us teach at medical universities, and we both work in continuous education (that is, we teach doctors, not medical students). It’s not like we automatically get (or demand) any preferences, far from it. But you know the Six Handshakes rule, and you know how it usually works: you find yourself in a tough situation, and it turns out you have an acquaintance who has a brother who has a friend who went to school with just the right person to go to in such a situation… Well, these chains of “friend-of-a-friend” relationships tend to be shorter in the medical community, and that helps. Especially if you’re after not just some help, but want the best help there is.
And I’m lucky. That helps a great deal, too.
I was on flu medicines, but those didn’t help much. I was taking so much paracetamol I started worrying about my liver. My family was worried, too; knowing I was reluctant to get tested my father used his medical connections to organize an off-the-record CT scan for me. I went there on Thursday, they had me scanned and told me that the picture was consistent with viral pneumonia, likely COVID-19 (as expected), that about 20% of my lungs were damaged, and that judging by some signs it was getting better already. It turns out they were wrong about that last part, but it gave me some reassurance and calmed down my family a bit.
I wasn’t getting any better. In fact, I was feeling worse. On Saturday I started coughing, and the cough didn’t sound very good to anybody who went to a medical school. Our daughter was obviously getting well, and my wife started really worrying about me now, nagging me to give up and call an ambulance.
I was still on my annual leave; actually, the next Tuesday we had planned to fly to Turkey to spend time with my wife’s family who got there a couple of days earlier, but we had already cancelled all that as soon as we knew we had COVID. I had also planned to go to work on Monday to deal with all the urgent stuff, and I had a rather important meeting with a colleague scheduled for that day. Of course, the way things were, I wasn’t going anywhere on Monday, so on Sunday, I texted the colleague explaining that our meeting needed to be postponed. That text saved my life.
The colleague called me back immediately. He wanted to know all the details, so I told him the whole story. This colleague came to work at our hospital1 only recently; in 2020 he directed a specialized COVID hospital in Moscow Region and was apparently so good at it he got decorated by the President of Russia. Of all the people I could reach without stretching it, he probably had the most experience and knowledge of COVID-19. It would be rather stupid not to trust his judgement.
“You need to go to a hospital,” he said when I finished answering the additional questions he had.
“That bad?” I asked, already sure I was going to follow his advice anyway.
“Listen,” he said patiently. “I’d have ordered you, but you are not my subordinate. Instead, I’m asking you kindly: please, don’t be a fool, get admitted to a hospital! Today. Immediately.”
“Alright,” I replied. “Tell me, though, as you probably know better than anyone I could ask: if you were me, which hospital would you go to?”
He asked me where I lived, paused for a second, and then firmly said, “Number 52. It’s close enough to you that you can get admitted there without too much hassle, and they are the absolute best. They have the best equipment and the best people. But you’ll need to call a private ambulance so as not to be diverted to another hospital. If you’re OK with that, I’ll try to organize everything. Text me your date of birth and full home address, and wait for me to call or text you back.”
It turns out, the ambulance system in Moscow is set up in a rather clever way. I may be wrong about some details since this was the only time I ever used it, but as far as I understood, they have a city-wide system set up. Moscow has numerous hospitals and numerous ambulance stations, and in every ambulance, there’s a tablet connected to the system. If a paramedic decides the patient needs to be taken to a hospital, they enter the patient’s data into the system, and the system calculates and tells which hospital to drive the patient to. It automatically takes into account the specializations of the hospitals in the area and the distance to suitable hospitals, as well as the number of free beds available. The only way to be admitted to a particular hospital is to already have a record in the system that says the particular hospital has a bed reserved for this particular patient, and even then an “ordinary” state-sponsored ambulance may opt for a closer hospital if it suits and has a lot of free beds, so as not to waste much fuel. A private ambulance will happily take you to the hospital that is waiting for you, because they charge you directly, and they charge for the distance driven, too. So that’s what my colleague was trying to set up for me: a record in the system saying that the hospital had a bed reserved for me particularly.
Half an hour later he texted me a phone number of a private ambulance service and – just in case – the name of the doctor in charge who approved reserving a bed for me. He set aside all his affairs and organized it all on Sunday afternoon (the sun was already setting when I stepped into the ambulance). I’m forever indebted to him; if it wasn’t for him, I might not have survived. I can say the same about quite a number of people I met in the consequent weeks, but this colleague of mine was the first link in this chain that kept me alive.
I was admitted to City Clinical Hospital No. 52. They did a new CT scan that showed the amount of lung damage was moderate (that is, 25-50% of my lungs were damaged, worse than 3 days before), brought me to the Nephrology building (repurposed for COVID patients), and hooked me up onto oxygen. In the evening they even had to give me a longer hose: I was feeling so bad I couldn’t go and use the bathroom without oxygen.
The next day I was feeling a little better; either the treatment was kicking in, or the extra oxygen supply throughout the night saturated my system somewhat. However, the doctor I was assigned to felt that the treatment they were giving me was not enough and wanted me to have plasmapheresis performed. During plasmapheresis, they take your blood and run it through a special machine that removes toxins or other unwanted substances from your plasma, and then return it back to your system. A number of things can go wrong during this procedure, and besides, to easily remove your blood and then return it a catheter in a central vein works better than a simple needle, and installing a catheter into a central vein is another procedure that requires extra care. To take no chances, they were moving me to an ICU two floors below for the plasmapheresis (of course the Nephrology building has its own ICU) and expected me back later the same day. That was what I texted my wife, she wished me luck, they hooked me up to an oxygen cylinder, and rolled me to the elevator.
I don’t know what exactly went wrong during the catheter installation, but as they were pushing the catheter into my subclavian vein my heart started feeling funny. I complained, they promptly hooked me up to a monitor, and there it was, the atrial fibrillation I had never experienced before. “Undress him, he isn’t going anywhere tonight,” I heard a doctor say. They took my phone that I still had in my hand, removed my wedding ring and what was left on me of my clothes. I was concerned: I told my wife I’d text her as soon as I got back to my ward later that day, and now I obviously wouldn’t; she’d be worried. If I only knew…
The rest of that Monday I remember only vaguely. Perhaps that catheter installation was the last straw that broke the back of my proverbial camel. They had to electrocute me to bring my heart back to normal operation. They installed a urinary catheter so that I didn’t need to go to the bathroom. They turned me face downwards: my oxygen saturation kept decreasing, and the lungs work better when you lie on your stomach. Doctors and nurses were hustling around me. It was hard to breathe, I had to concentrate on the process, and little by little my mind drifted off into oblivion.
ICU No. 7
Back to Life
I woke up to a pat on my arm and a soft but insistent female voice:
“Sir! Can you hear me, sir? Do you know you can’t talk?”
Opening my eyes seemed like a huge endeavour. I managed to move my head just a little, signing a negative answer.
“You can’t talk, sir, because you have a tube in your throat, right here,” she touched the tracheostomy tube. “Don’t attempt to talk, you could harm yourself. Do you understand?”
I nodded “yes”. So they did a tracheostomy, I thought, presumably to put me on a ventilator. So many new procedures in just one day!
I opened my eyes. It wasn’t the room I fell asleep in, though I obviously was still in an ICU. I was lying on a bed surrounded by a number of machines that were whirring and beeping in various patterns, in a hall that opened into a corridor on my right. There was another bed on the other side of the hall with another person lying there, also surrounded by machinery. I had so many tubes and wires connected to my body I was afraid to move. Not that I could move much, I could barely just lift my hand. The bed was slowly moving, the mattress shifting under me (“to avoid bedsores,” I quickly guessed), and it felt nice. My lips were dry, drier than I remembered them ever being, and my head was dizzy; thinking straight required enormous concentration. It felt like the worst hangover I ever had, only worse.
A nurse came. She seemed genuinely glad I was awake. She told me she was a student at the university where I work, and she recognized me as a psychiatry teacher (I don’t teach students, so she probably recognized me from my work at the admission committee). She gave me a non-spill bottle of water and showed me how to use it. I was so parched! I put a little water in my mouth, and it felt gorgeous, but the moment I swallowed it my mouth would become drier than a desert again.
Sometime later, a doctor came. He was very cheerful and also glad I was awake. He said I’d been through a lot, but didn’t go very deep into details. He mentioned that my kidneys started failing, and with all the medicines they gave me my liver enzyme levels raised more than three times above the normal values (which is a universally recognized sign of a DILI, drug-induced liver injury), so they had to cancel most of the therapies. He also mentioned that my blood glucose levels were very high (I later learned that everybody was sure I had diabetes, but in fact, it was just my pancreas failing, and that was the reason I felt so thirsty; less than a week later it was back to normal, and a lot of doctors were very surprised). The doctor, however, was sure all these problems could be solved in time, though he admitted it would be a lot of work. He went on to explain how I had to try to breathe in a particular way to help my lungs heal, and tweaked the ventilator machine a little.
Something was off in what the doctor told me, but it took me quite some time to figure it out: all these events couldn’t possibly fit into one night. It wasn’t Tuesday when I woke up. I must have been unconscious for a few days — at least! How much time had passed? As I drank water, something about my lips felt funny. I managed to raise my hand and touch my lips and chin; I no longer had a full beard, it was merely a stubble — quite a long one, over three days old. They must have shaved me, and it grew back since then…
How long was I lying there? I was suddenly very worried. How was my wife? In our family, I do a lot of the housekeeping; for several years my wife didn’t even know how to start our washing machine. How did she manage, with our little baby and all the housekeeping? How was our daughter? Did she get well? And what about my work; there were several important deadlines coming — had they already passed? There were some things only I knew exactly how to do; did the team figure it out, did they manage to get help? I had no way of knowing. Rationally, I knew my wife was strong and bright and could handle anything life threw at her, but I couldn’t help worrying. I knew the team at work was seasoned and professional and was able to handle things; I still was concerned, but after all, it was just work. My family was what worried me the most. And I missed them, my wife and daughter, I missed them so much!
The next morning, as the nurse changed my bandages, she wrote something on each of them with a sharpie. I raised my right hand and managed to focus my sight on the bandage over a catheter sticking in my forearm. Written over it was the date. The next Monday. This meant I first woke up on Sunday, having spent five full days in a coma.
Reconstruction of Events
They didn’t ever tell me the details of what happened during those five days. I guess they had a point: even the general and vague information the cheerful doctor gave me, combined with what I remembered from six years of studying general medicine, got me rather scared and worried for my life. Had they told me everything at once, who knows how I would react. Still, I could guess a lot of things from what was said around me. Also, my wife talked to the doctors every day, and she knew about my condition much more than I did; she told me many things later. So here’s what I now know, combined from various sources.
On Monday, when I was first moved into the ICU in the Nephrology building, my condition kept worsening. The hospital’s Head of Nephrology, the chief of the whole Nephrology building, personally insisted and persuaded everybody that I should be moved to a specialized pulmonary ICU (she saved my life, too), and eventually, she was heard, so on Tuesday, I arrived at ICU No. 7, the specialized pulmonary one. By that time, my lungs were unable to put enough oxygen into my blood for me to live, even if the ventilator supplied me with 100% oxygen (the air we usually breathe contains about 21% of oxygen), so they hooked me up to an ECMO machine.
I only later learned that ICU No. 7 of CCH No. 52 hosts the Moscow ECMO Center, and it was actually the only place in this part of Russia where I had any chance of survival at all. I learned that critical patients are transferred into this unit from all over Moscow and the western part of Russia; I saw a report of a patient transferred from Krasnodar (that’s about 1200 km from Moscow) on national television, and there were familiar staff faces there on TV. Still, when the time comes, ECMO needs to be initiated fast, and I am not sure I would even make it if I wasn’t in the same hospital, to begin with. I’m lucky, I have already said that.
During the next few days, my organs started failing one by one. One of my kidneys shut off, another one was very close, too, but the doctors fixed this promptly, so the renal failure lasted less than 24 hours in total. My adrenal glands failed to produce enough hormones, my liver was reacting to the excessive amount of medications I was receiving, and my pancreas was not functioning properly either. On top of everything, I had blood poisoning, so they had to use advanced machines to clean my blood every day. They performed a new CT scan on Thursday (exactly a week after my first off-the-record CT): the amount of lung damage is recorded as “critical” (that is, more than 75% of the lungs; I was later told it was about 95%), and there were also signs of bacterial infection in addition to viral. They put me on antibiotics, to which my intestines reacted in a totally expected manner and stopped functioning properly. My body really gave the doctors a lot of work, and this wasn’t even the end of it yet.
The Wonders of the Modern Medicine
As I started to feel a little better, I naturally started wondering what all the equipment around me was for and what it did. You see, I’m a psychiatrist, and I’ve been working in this field ever since I graduated university2. My job hardly involves any somatic (“bodily”) medicine at all, so almost all my knowledge of it is what remains from what they taught me at the university, which I graduated 15 years ago. Back then, most of the equipment I now saw around me was either not available in Russia at all, or so rare that a simple medical student in St.-Petersburg had no chance of ever seeing it in action. I vividly remember my first “real” dialogue with a nurse (at first my coordination was so bad I couldn’t even point at the huge letters they printed out on a sheet of paper for me, but a few days later I re-learned to write so fast that a conversation became possible):
“Why is it beeping in this manner?” I wrote and pointed my pencil at the monitor.
“Your blood pressure is high,” the nurse replied, and turned the monitor a little so I could see the readings.
“How does it know my BP? There’s no cuff on me,” I wrote back.
“Arterial catheter,” the nurse smiled. “It is connected to the monitor, so both systolic and diastolic pressure can be assessed constantly.”
Wow! Back when I studied at the university, installing an arterial catheter was quite a rare procedure; here at ICU No. 7 it was routine: they regularly wanted arterial blood samples to test for gases anyway, so installing a catheter was only logical, and once it was there, why not hook it up to the monitor and get rid of the cuff.
And the little machine that they connected to the line leading to my venous catheter! It supplied me with a drug, 24/7, at a constant rate of 3 ml per hour, and it could easily do 0.3 ml per hour if required! Apparently, it’s a commonplace device today, but for me, it was absolutely amazing. Imagine yourself 20 years ago being given the device you’re reading this text from, or imagine giving a SpaceX Dragon to Leonov and Belyaev instead of Voskhod-2 — that’s how I felt about the equipment around me and the procedures I was witnessing.
Even the ventilator I was on was really advanced. At first, it did what a classic ventilator would do, simply push the air in and out of my lungs (of course, it didn’t have to be simple air, the doctors could set up any percentage of oxygen). When I got better and my lungs started actually working, the doctors changed the settings and the machine would adapt to the way I breathed, automatically adjusting the amount of air and the breathing rate. Later, they set it up so it wouldn’t push any air unless I started inhaling on my own so that my body would get used to breathing on its own again. And all the while the machine would of course keep monitoring my breathing, raising alarms if I wasn’t breathing optimally. And they had a portable version that could do almost all the same things; they used it when I needed to have a new CT scan to transport me to a scanner one floor below and back to the ICU. Amazing, really!
But the most wonderful was, of course, the ECMO machine, the one that saved my life when my lungs didn’t work. ECMO stands for Extracorporeal Membrane Oxygenation, and what it basically is is an artificial lung, together with a pump, a bunch of sensors and a sophisticated control unit. I had a thick hose (thicker than my thumb!) stuck in the femoral vein (on my leg, near the crotch), and through that hose, my blood was fed to the machine. You may remember that a lung basically works by removing excessive CO₂ from blood (and exhaling it) and replacing it with O₂ that was inhaled. Well, that’s what happens in the ECMO machine: via some advanced membrane magic, CO₂ gets removed and O₂ is placed into the blood. Bright-red (oxygen-rich) blood is then returned back into the patient’s body, for that, I had another hose (a little bit thinner, but still at least as thick as my thumb) stuck in the jugular vein on the side of my neck. Sounds rather straightforward, but there are hundreds of caveats about this whole process, so the machine is quite complex, with a lot of tubes and myriads of tweakable parameters, and requires regular supervision by people who know what they’re doing.
Even more amazing (than the sheer fact of its existence and availability) is the ECMO machine’s “transport mode”. Of course, the machine requires oxygen and electricity to operate, so it is usually plugged into AC and O₂ wall sockets. When a doctor said I was to be taken downstairs for another CT scan, even some of the nurses (who were relatively new in the unit) were surprised: how do you move a person who “breathes” via a machine that needs to be plugged? It turns out, you can take the most essential part of the machine (the pump, the little can with membranes, the minimal control unit and the three most vital sensors), connect it to a battery and an oxygen cylinder, and you’re good to go. There’s no way to change any settings in this mode, and you can’t go like that forever (all the other tubes and sensors are there for a reason), but it works and allows to move the patient to another ward, another floor, or even another hospital. It does look scary, a pump and a can of your own blood simply lying there across your feet without any casing, but the technology is simply awesome.
Not Quite There Yet
I was getting better little by little. My lungs were still bad, but other organs healed. I was allowed to eat by myself (they fed me through a tube before), first the fibre-protein liquids, then human food. The fibre-protein liquids come in two tastes: disgusting and tasteless, so I was really glad to be allowed to eat some soup and porridge. Well, they fed me with a spoon, like a little child, my hands were still too weak and shaky, but nevertheless.
One day, the cheerful doctor came smiling. He put a thick hose to my nose (like the one they used to supply me with oxygen the first day I came to the hospital, but three or four times thicker) and turned the ventilator off. I wasn’t breathing with my lungs anyway, and the flow of oxygen-enriched air through the hose would provide enough pressure to spread my lung tissue so that it would heal. And since I no longer was on the ventilator, he replaced the tracheostomy tube in my throat with a specially modified one. With that new tube, I could talk! The doctor ordered me to speak as much as possible (so as to keep my vocal cords in action), so I did.
I was still worried about my family. I missed my wife and daughter so badly that every time I was left alone I would find myself in tears. I later learned that my wife came to the hospital three times a day, every day that I spent in the ICU. She wasn’t allowed to visit me because of epidemic restrictions, but she came anyway, just to be near. Sometimes, especially in the evenings, she would drive, but most of the time she walked all the way, with our daughter in a stroller. It’s a 6 km walk (and another 6 km to get back home), but she would come again and again. She recorded and sent me a little video every time she visited. She knew I wouldn’t see those until later; in ICU, a patient is only allowed to have a bottle of water and a toothbrush, all other belongings including phones are stored elsewhere. She talked to my doctors nearly every day, she even ordered pizza for the staff, she did everything she possibly could (and a little more) to help me get better. I think her presence and support helped a great deal. I wouldn’t have made it without her.
Perhaps I was worrying too much: several days later my blood tests got worse, it looked like I was losing blood. The surgeons came and performed an EGD, and indeed I had developed ulcers in my stomach and duodenum. “Typical stress-induced ulcers,” they said. These ulcers were bleeding, and the surgeons did their best to clip every ulcer.
To see whether the bleeding was indeed stopped for good, the doctors needed to put a tube in my stomach, and such a tube is better installed through the nose instead of the mouth (so the patient doesn’t bite it). They replaced the “talking” tube in my throat with an ordinary one, put me back on the ventilator, removed the air hose from my nose, and put a tube in there. I wasn’t allowed to eat or drink anymore (they put glucose and liquids in my vein instead). They started blood transfusions to compensate for all the blood I’d lost through the ulcers.
It wasn’t working. Every now and then a doctor would take a syringe of water, push that water to my stomach through the tube in my nose, wait a bit and then drain what was in the stomach back through the tube; it came back red, with fresh blood. The next day the surgeons did another EGD; I was still bleeding, from right under the clips, so they electrocoagulated every point of bleeding. They did the same the next day. It wasn’t getting any better, my blood simply wouldn’t clot. The blood tests showed my platelet count was very low, as were the levels of the plasma proteins that facilitate clotting. I was getting transfusions of platelets and all the necessary proteins, but the levels wouldn’t elevate. At one point I received 15 transfusions in one day, and it didn’t make any difference. My spleen became enlarged, trying in vain to cope with all the blood issues I was having. The cheerful doctor said it looked like I didn’t want to be discharged before trying every procedure the ICU had; he was only half-joking.
Eventually, the doctors came to the conclusion that the source of the trouble was the ECMO machine. It’s a rare occasion, but not unheard of: sometimes the platelets and the plasma proteins start to sediment on the machine’s membranes, and the pump blades rotating through the blood at over 4000 rpm don’t help to preserve all the blood elements either. The same machine that saved my life two weeks before was now trying to kill me! Luckily, my lungs were healing, and – being helped by the ventilator and extra oxygen – could already put enough oxygen in my blood. The doctors put the ECMO machine on idle for 24 hours (the pump would still run blood through the machine, but no gas exchange took place); the oxygen saturation was good.
Meanwhile, the bleeding was getting worse. I woke up in the morning and noticed that the bandage over the arterial catheter on my right forearm was soaked in blood. I called a nurse, she called a doctor, and the doctor said I didn’t need that catheter much anymore and ordered it removed. The nurse removed the catheter and put a tight bandage over the artery; the bandage was completely soaked in blood in a minute and a half. A thicker and tighter bandage managed to hold for two minutes. The nurse had to press a bandage hard against my artery with her fist and hold it that way. She held it there for 80 minutes, while the doctor was busy saving another patient’s life. My forearm hurt a lot, the nurse was obviously exhausted, but we kept smiling at each other; we both understood that if she as much as relieved the pressure a little, I would probably bleed to death. When the doctor finally came to help, it took him another 30 minutes and a lot of hemostatic sponge to get my bleeding artery under control. They took me off the ECMO later that same day, and the surgeons did another EGD to coagulate the new bleeding spots in my stomach.
The next day the water pushed through the pipe in my nose returned from my stomach clean. The bleeding stopped. It really was the ECMO machine that caused the problems. And I was lucky — yet again! — that I could breathe with my own lungs; a week earlier, I wouldn’t have survived without ECMO. Some of the doctors were quite surprised with my lungs’ performance. My blood test results were improving. I was allowed to drink and eat, first liquids, then human food. In a couple of days, the surgeons did another EGD; they didn’t put me to sleep this time, so I could see and hear the surgeon’s confusion as she tried to locate the places where my stomach was previously damaged — it healed so good.
I spent a few more days in the ICU. I was allowed to get my phone back, under the condition that I wouldn’t openly use it during the day (it was against the regulations, after all, yet they allowed the healing patients to use their phones — being able to communicate with family and friends does help the healing process a great deal)3. I spent hours and hours watching the videos of my daughter that my wife had sent me. My lungs were getting better, and the doctors gradually removed the support I was getting from a ventilator. One day, I started coughing up huge (up to 1.5 cm long) pieces of something that turned out to be the scabs that covered the insides of my bronchi. With those out and the air passage further improved, the doctors took me off the ventilator and onto a simple oxygen line, exactly like the one I was breathing from when I was first admitted. I could already sit up on my bed, I ate all by myself, and they removed every tube and catheter from my body except for one catheter in my vein that they still used to take blood samples and administer medicines. One afternoon a doctor removed my oxygen support to see how I would do without it. I did well: the oxygen saturation would drop rather dramatically if I did something (like sitting up or eating) but would return to acceptable (though still a little below normal) levels as soon as I rested. They still put me back on oxygen, for the time being, to avoid unnecessary stress. The doctor asked me to sit up and carefully hang my feet off the bed. I immediately got dizzy, and had to sit for good ten minutes before I got back to normal; I never thought the orthostatic intolerance after just a couple of (well, three, to be exact) weeks in bed would be so intense, it felt like I was very drunk. After the initial effect subsided, I was allowed to stand up. The doctor and a nurse held me from both sides, my legs were weak and shaking, yet I managed to make a few little steps to and fro. It was surprisingly hard.
The next day I was discharged from the ICU and moved back to the Nephrology building. I didn’t feel like I was ready yet (how would I go to the bathroom if I couldn’t stand up without two people holding me?), but I obviously no longer needed to be in ICU to survive, and there surely were people that needed that bed much more than I did. As they rolled me from one building to the other, they put my medical chart on my knees: two volumes, as thick as my arm — I did give these people a lot of work!
Both the intensity of what I’ve been through and my awe of the procedures and equipment fade in comparison with the biggest impression from ICU No. 7: the people that work there.
Being a son of two doctors and, a doctor myself, and married to a doctor, I’ve been around medical professionals my whole life. Medical professionals in real life don’t look like the medical professionals in movies or TV series. Perhaps, every medical student aspires to be like the doctors in the movies: they may have huge problems in their personal lives, they may have trouble dealing with their superiors and colleagues, but as soon as they put on a white robe or whatever uniform they have, they turn from mortals into superhumans, knights in shining white robes that care about nothing but the patient’s wellbeing and can work for 72 hours straight to save lives and cure the most severe diseases. In real life, it never works that way, you don’t magically forget everything but work, you remain a mortal human with all your flaws and all your troubles, even if you put a white robe on. If you don’t work in ICU No. 7, that is.
The staff there was all superhumans, knights in shining protective suits, every single one of them, from janitors and orderlies to nurses and doctors, every minute of every day and night. They were exactly like in TV series, always caring, always eager to help, always tactful, professional, knowledgeable and kind. And the teamwork I witnessed! Everybody was always covering each other’s back, everyone was always ready to give a colleague a hand. And everybody was contributing to the spirit of confidence, reliance and good humour. I knew that a lot of people died in ICUs; the survival rate for patients requiring a ventilator is much lower than 100%, and the survival rate for patients requiring ECMO is even lower than that. Granted, ICU No. 7 has world-class specialists and top-notch equipment and its patients have better chances than anywhere in Russia, but the patients they have are among the most severe in the country, too.
“I’m so glad to see you in such a good condition!” one of the nurses said to me one day. By that time, I was in a separate single-bed ward, they moved me there just as my stomach started bleeding. “This ward is definitely turning into a lucky one! MakSim4 got better here, and now you are healing amazingly well.”
“So it wasn’t lucky before that, I guess? The ward”, I asked.
“No, not so much”, she replied with a sad note in her voice. “But it’s such a great joy when a patient does get better, you can’t imagine!”
So people died in ICU No 7, too, but I didn’t even think about it much; that spirit of confidence and professionalism in the air allowed no doubts: I was in the best hands possible, and I was going to get well. For sure.
Usually, in a hospital, you get assigned to a doctor, and that doctor treats you, day after day. Of course, the doctor is not available 24/7; at night or on a weekend there is a doctor on call (usually a 24-hour shift with one doctor covering a whole unit or even several) for emergencies. In ICU, it’s a never-ending emergency, so you get assigned to a new doctor every day, for 24 hours. And of course, the doctors help each other, so you end up being treated by the whole unit. The same goes for nurses. Also, when I was getting better and closer to be discharged from the ICU, occasionally a nurse or a doctor would come by, ask me how I was doing, express their joy, and wish me all the best and speedy recovery. Sometimes I would remember the face but not the name, sometimes even the face would be unfamiliar, but these people obviously knew me and my history. They must have treated me at some point, perhaps when I was still unconscious, or the first few days afterwards, when my brain was still not working at full capacity.
There was something very human about the staff, too. Every morning, the nurses would be writing the names with sharpies on each other’s chests (and have a little calligraphy competition there). Almost everybody had something distinct in the way they dressed, something against the regulations5; often a bright cap instead of the standard-issue single-use one, or a ski mask with a name written in huge letters on the band instead of protective goggles. Some doctors would have their last names or initials written on their face masks, or wear no mask at all (with the amount of viral load around, face masks and goggles hardly make any difference there anyway). One of the doctors always wore black protective suits instead of the standard-issue white ones that everyone else had. I remember wondering what was wrong with one of the nurses – his outfit looked in total accordance with the rules – until I finally noticed a bright patch on his shoulder; the patch read “Class B Biological Waste”… I could always identify the people coming from elsewhere in the hospital (surgeons, radiology specialists, various consultants, etc.) by their to-the-regulations outfits.
As I’m writing this, I’m fighting the temptation to start naming people. How can I not thank the doctor who, seeing how desperately bored I was and how badly I missed my family, gave me the book he had in his locker “for the occasions of a slow day”? I’ve finished that book by bedtime the same day, but that whole day it kept me occupied. How could I not thank the nurse who kept bringing me old magazines on history that his father no longer wanted to keep? How could I not thank the nurses who stopped by my ward even if I wasn’t assigned to them on that shift to chat a little and make sure my spirits were high? How could I not thank the doctors who found time to talk to my wife on the phone and patiently shared the news and prognoses with her? How could I not thank the orderlies who changed my sheets every couple of hours when I was sweating? There were too many people who did their best to save me, heal me, and make my life in ICU much more enjoyable; I would certainly forget to mention some people, and that would be unfair. I have a special place in my heart for every single person on that staff.
Still, there are three doctors that need to be named and mentioned separately.
Sergey Vasilyevich Tsarenko is a star. I constantly see his name in the news concerning the treatment of COVID-19. I’ve heard people calling him the best intensivist/anaesthetist-resuscitator6 in the world. From what I’ve read, many of his peers seem to think he is at least among the best in the field. He is a professor at the Moscow State University, and in CCH No. 52 he is the Head of Intensive Care, overseeing all the ICUs. The staff calls him “the Professor”.
His authority among the staff is indisputable, the respect is enormous. He even looks mighty: very tall, with a high forehead and noble facial features. And he, I think, was the main source of that spirit of confidence and caring in the ICU. He cares so deeply about every patient, I wonder how he even copes mentally. An extraordinary doctor, and an extraordinary person. He saved my life, but even more than that, I’m thankful that I had a chance to meet him and see him at work; I didn’t know such doctors existed and knowing that now gives me extra hope and some faith in humanity.
I was told that he personally was taking a great part in treating me during my first week in ICU No. 7 and overseeing my case for the rest of my stay there. I believe it: there was one thing about him that was immediately out of place when I first saw him. He does daily rounds in ICU No. 7 (and other ICUs, I presume), gathering all the doctors around every patient and discussing further treatment. In my life, I’ve seen a fair share of figures of authority (professors, hospital brass, etc.) doing ward rounds, and it usually looks the same: the doctor in charge tells all the important stuff about the patient and the latest changes in their condition, then a discussion follows, and then the authority figure gives recommendations. Back when I first saw the Professor on Monday after I first woke up (he did no rounds on Sunday), something struck me as uncommon. It took me a few more days to pinpoint it: Sergey Vasilyevich never asked for any information about me, he would ask me how I was feeling and start the discussion right away. He didn’t need any information, he already knew my case better than anyone in the room.
“Don’t you even dare get worse!” he told me the day I was discharged from the ICU. I couldn’t disobey.
I also have to mention Denis Petrovich Pavlov, the cheerful doctor, known around the unit as “Petrovich”, of course7. He is somewhat quick on the draw, and that led to a couple of unpleasant moments for me, including an EGD without sedation (a very interesting experience that I wouldn’t recommend) — Petrovich organized the surgeons to come and perform it so quickly he didn’t have time to coordinate with other doctors, and it turned out they needed me non-sedated a little later. I hold no grudge against him: he was always frank with me, he would always answer a direct question in full, so I could have an idea about what was going on with me and how bad it was likely going to be next. His frankness and his sense of humour (a little bit on the dark side, admittedly) helped my spirits a lot.
He also was reckless enough to pull out his phone and videocall my wife, once when I barely woke up and again when I had the “talking tube” installed — I’m sure that was against the regulations. We could see each other, the second time we chatted for quite a while, I could see my daughter and my mother who just came to visit that day. Even if he did nothing else for me, I’d owe him – big time – for that alone.
There is also a very special place in my heart for doctor Andrey Alexandrovich Krylov. Quiet, very cautious, very thorough, he didn’t talk much, and he was always extremely careful in his prognoses — much more so than any other doctor. Yet it was he whom the Professor later credited for the timely decision to take me off the ECMO, and it was he who helped put my mind at ease the one time I was on the verge of despair. It was during my stomach bleeding: mere days ago I was eating meat and talking, now I was back on the ventilator, I wasn’t allowed to even drink water, let alone eat, and there was no positive progress in sight; I came really close to completely losing heart. Andrey Alexandrovich happened to be my doctor that day, and he managed to find just the right words and assemble them into just the right sentences to calm me down, revive my hope, and restore my confidence. I don’t know if I would hold up without him.
I was back in the Nephrology building, in the same ward I started in. I had my things back, so I could get dressed and use my laptop, yet I couldn’t really get out of my bed yet. The next day, when my wife got me compression stockings, I was allowed to try and stand upright. It was significantly easier than the first time, two days before. Three days later I could walk around my single-bed ward without a walker or any support, and was even allowed to go to the bathroom without staff supervision. I was allowed to turn off the oxygen for short periods of time, gradually increasing the total time spent breathing normal air. I wasn’t allowed to do anything work-related, but I did some programming, and my brain seemed to be functioning as usual; quite a relief considering how many people complain of thinking and concentration difficulties even after mild COVID-19 cases. By the end of the first week, I was completely off the oxygen and was allowed to walk about 20 meters to the water cooler to fetch some hot water and make tea whenever I pleased. My CT scan results improved from “critical” back to “moderate damage”.
They still kept me in for another week, just to make sure; the thickness of my medical chart warranted caution. Eventually, I was discharged and put in home quarantine for 14 days, despite me having negative PCR tests for a month, as well as antibodies test showing no active disease for three weeks — the protocol should be followed.
As I’m writing this, my home quarantine is still ongoing, so it is a little bit early for final results; still, I think it’s safe to say I’ve already had COVID-19 and survived it. Barely. I guess it’s a good thing I’m not yet allowed out, my immune system is hardly prepared to take the autumn at full force yet. My heart starts racing under load, though I can hold and rock my daughter for some time already. I still take quite a lot of medicines to help my heart and lungs. I’ll have to wear my compression stockings for several weeks. I’m instructed to take it easy with regard to physical exercises, I won’t be cycling until spring, and there’ll be no snowboarding for me this winter. I’m strictly forbidden to fly planes, dive, and inflate balloons for at least half a year, and I was told not to sing or play the recorder, either. That’s the way the human body works: breaking things takes seconds, repairing them takes months.
I lost a month and a half of my life, and I’m not going to be fully functional for quite some time. I missed my daughter growing most of her teeth and learning to walk on all fours and sit up on her own. I caused an enormous amount of worry to the people I love. I lost about 13 kilograms, but that’s a good thing. I probably lost a patch of hair on the back of my head, where the bedsore is still healing; it is very seldom that hair grows back where a bedsore was. The amount of grey hair I have increased dramatically. I lost confidence in my body: it used to feel like nothing critical could ever happen to it, and if something did happen, it was easily fixable; now I know how fragile my body is.
I acquired experience that, thankfully, not a lot of people have ever had. I met wonderful people and awesome professionals. I had a rare opportunity to really see how much the people I love care for me. I had a vanishingly rare opportunity to see what is really important for me, what I actually really care about.
Parents and family in general aside, I always made a point of making as few debts as possible and repay what I owe as soon as possible. Now I’m indebted to a whole lot of people, and I hardly have any chance of repaying those debts — ever. This is a huge paradigm shift for me, and I have yet to learn how to live my life from now on.
And of course, the thought crossed my mind more than a few times; with all my privilege and luck, and with all the COVID-19 stats we have. The very fact that I was given a bed in that ICU, an ECMO machine, and all the attention of these amazing specialists, and that my life was eventually saved as the result, means that somebody else was denied all this. Another person could have been saved instead of me, a much more worthy person, too. Did I deserve all the hard work? Did I deserve it more than someone else? These questions are very unnerving. Of course, the thought that She must have wanted it this exact way gives some solace, but I can clearly see myself in various situations in future, pausing and asking myself: is this here what the Professor and his team saved my life for? I can not afford an average and meaningless life any longer, I need to live a full, happy, and long life. I owe all the people who worked hard to save me at least that.
No, I didn’t just lose the month and a half. It may sound like blasphemy, but looking back, I’m glad I’ve experienced all this. Of course, I do not recommend following my steps. Please, stay safe and healthy, everybody, it’s much better that way!
In Russia, clinical departments of medical universities are usually located in hospitals where students can see the patients suffering from related diseases. A person teaching a clinical subject (as opposed to non-clinical subjects like Chemistry, Latin, or Philoshophy) is usually required to hold a certificate in the corresponding specialization (and renew it regularly, just like any doctor working in the field) and do the consulting in the hospital where the department is located. It is also quite common for a medical university teacher to hold a part-time position at the hospital; university departments often employ one of the hospital’s Deputy Chief Physicians part-time to give lectures on the peculiarities of the current legal framework and documentation requirements that the academic staff is rarely well-versed in. ↩︎
To become a doctor in Russia, you first go to a medical university (the six-year course of “general medicine” roughly equates to receiving the “M.D.” degree in the English-speaking world) and then study to get a particular specialization (thoracic surgeon, ophthalmologist, etc.) at least 2 years (can be up to 5 for the most challenging specializations). ↩︎
Absense of communication isn’t usually an issue since visits are allowed 24/7 in all the ICUs of CCH No. 52. However, this policy is on hold due to all the COVID-19 situation, hence the phones. ↩︎
In the “red zone” where COVID-19 patients are, the staff is required to wear protective suits, caps, N95 (or better) masks and protective goggles and/or visors. ↩︎
In Russia, intensive care doctors are called anaesthetists-resuscitators. It’s a separate specialization (along with cardiology or psychiatry, for example) and requires more training than most of the other specializations. ↩︎
The patronymic “Petróvich” denotes a son of a man named Pyotr (the Russian version of Peter). Something about how it sounds and rolls off your tongue makes it quite common for anyone having this patronymic to be colloquially called “Petrovich” (omitting the first name), something that happens with other patronymics much more seldom. Pyotr is not the most common name, but it is still widely spread, so you encounter a Petrovich every once in a while. ↩︎