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As a physician who manages patients in the ICU, I provide care for a broad range of patients in the medical and surgical categories, including patients with sepsis and COVID. Even though our hospital provides more than adequate PPE, the possibility of contracting COVID remains significant, and recently happened to me. I hope telling my story will benefit others and inspire efforts to develop better treatments for this treacherous disease.
Day four of the annual professional meeting began like so many others: I had one more talk to give, and then a dash to the airport for the flight home. At lunchtime, I noticed a slight headache. By the time the session began mid-afternoon, the headache was worse. I bummed a couple of over-the-counter pain pills from a colleague (thank heavens for better prepared friends!), chugged a bottle of water, and listened to the three talks that preceded mine.
As a nurse practitioner in a Level One Trauma center at UF Health, I know the signs of sepsis; I pay attention to the presentation with my trauma patients, but I never imagined that I could develop sepsis if I ever fell ill. Like every essential worker, I also was informed and alert about the risk of being exposed to COVID-19 from my patients and from my coworkers. I was mindful of the guidelines to wear my mask and avoid group settings. I was compliant. Overall, I felt I would eventually be exposed and get sick, but I was mostly unconcerned about what that meant.
Initially, I thought I had a cold that wouldn’t be anything serious. However, I felt an obligation to be checked for COVID before seeing patients. After my nose was swabbed I said to myself, “Now I know what patients experience when I order a COVID test, and it is not fun!” To my surprise my test was positive. My wife was also positive. After a week of self-quarantine, I was admitted to the ICU; I was weak, slow to respond and severely dehydrated. Like some of my patients, I had COVID and the infection led to sepsis. I received IV fluids, antibiotics and all of the medications that the available evidence at the time justified.
I really missed my wife. I felt isolated and cut off from everyone outside of the medical personnel. She could not visit. We talked on the phone a lot, and I was relieved to learn that her symptoms were minimal. Unfortunately, things got worse for me.
My oxygenation dropped to levels that were incompatible with life. I was given high-flow oxygen at the highest settings possible. I experienced delirium and required sedation. I had shaking chills, abdominal pain and difficulty breathing. I felt terrified, miserable, and lonely. I was fortunate to have nurses who did all they could to ease my suffering. The respiratory therapists were vigilant. My doctors worked diligently and put a lot of thought into every medication, test and supportive measure. I felt that I was getting the best care possible. At the same time, I knew that in spite of everyone’s best efforts, death was a strong possibility.
My medical team discussed possible intubation. With my chest X-ray showing severe lung damage from the virus with pneumonia and my age of 73, I knew that after intubation I could be entering a pathway to death and that even if I survived, rehabilitation would be long with an uncertain outcome at best. I decided that if intubation was recommended, the procedure would be the only chance I had left and that I would go for it. Fortunately, I did not need to be intubated.
Over the next few days, my oxygen requirement steadily decreased and my other symptoms subsided. However, there was another surprise. When I tried to get up, even with the nurses standing near to help, I couldn’t stand. I had always been able to help others. Now I felt helpless. This helplessness shocked and frustrated me.
Over the next few days of a total 11-day ICU course, I progressed quickly to the point where the physical therapists advised my physician that I could be discharged to home. I was on cloud 9000 when I called my wife, and she told me she would meet me in the parking lot. The nurses then put me into a wheelchair to take me to her. My joy shattered as I was wheeled through our unit reserved for COVID patients, and I heard the sobbing of visitors whose loved ones were dying. I resolved that after discharge I would focus my energies on doing all I could to alleviate the suffering caused by this cruel disease.
My recovery has not been problem free; although I still am working through the challenges, I am thankful to and will never forget all of the health professionals who care for me in spite of the risk to themselves and who recognized the signs of sepsis early enough to save my life. I am now even more acutely aware of the nexus between COVID and sepsis. Every health professional needs to be.
-Dr. Simpkins is the president and chief innovation officer for the Vivacelle Bio, Inc. Northeast Indiana Innovation Center in Fort Wayne, Indiana.
To kick off Sepsis Awareness Month this September and expand your knowledge, register today for a one-hour webinar at 2 p.m., EDT, September 3. Amesh Adalja, MD, FIDSA, senior scholar from Johns Hopkins University Center for Health Security, will discuss the role of emerging infectious diseases, including COVID-19, which can lead to sepsis. Dr. Adalja will cover the historical relationship between sepsis, coronaviruses and other pathogens; assessing the need to escalate care; identifying at-risk patients; host-based diagnostics; and improved patient management strategies. This webinar is hosted by the Sepsis Alliance and sponsored in part by the Solving Sepsis Program in BARDA's Division of Research, Innovation and Ventures (DRIVe).
Then it happened. I was at work and suddenly I wasn’t feeling well. I had horrible chills and wanted nothing more than to go home and get into bed. I left halfway through my shift, which is something that I thought I would never do. I coincidentally had COVID-19 testing scheduled the next day as part of my company’s “back to work” plan, so I went and got tested. By the next day, I had started to feel worse. I had a headache, body aches, and some mild shortness of breath. I had abdominal pain and diarrhea. Still, I was sure the test would come back negative. It didn’t. At 7:00 at night, I got a message that said my test was positive. I just stared at it. I had so many questions. What about my family? Whom had I exposed? What do we do next? What is going to happen to me?
Luckily, I had quarantined myself away from my family starting the minute I got sick. No one else had symptoms. I was in my room and office, using my own bathroom; they were bringing me food on disposable plates with disposable silverware. I even set up my own garbage can to keep my stuff separate.
I felt terrible, both physically and emotionally. My shortness of breath got worse. As a healthcare worker, I was fortunate to be stocked up with thermometers, pulse ox probes, a blood pressure cuff, etc. I watched my oxygen levels drop lower and lower. I had a fever every day despite taking Tylenol around the clock. I was winded walking to and from the bathroom in my own room. I was scared, but I tried to put up a brave front; I didn’t want my kids to be scared. I just kept wondering how much worse it would get before it got better. During this time, I did not consider sepsis in myself. I knew I was sick but sepsis was furthest from my mind. However, we all need to consider the signs of sepsis that may present with mental confusion, fever, shortness of breath, feeling of dread, amongst others. Perhaps I should also not just have been asking how bad will my Covid-19 experience become, but whether this infection would lead to sepsis. As a healthcare provider, I should have known to ask myself whether signs of sepsis were presenting.
After about five days, the nausea and vomiting started. I had been trying hard to take in enough fluids, but then I couldn’t take in anything. Even a sip of water would make me sick. I knew I needed to go to the hospital, but I couldn’t bear the thought of going. I couldn’t even imagine how I would get to the car and walk into the ER. And wait. The trip seemed too exhausting to even consider. My primary care doctor was in close contact with me that entire first week, and she did what she could to get me through, but there are no approved outpatient treatment options. I finally agreed to go to the ER.
With the vomiting, pounding head, and dropping oxygen levels , I was relieved to be getting help. The staff started me on oxygen. I had a chest CT scan that did not look great. I got steroids and antibiotics. The staff convinced me to stay.
I was admitted for a week. I had elevated inflammatory markers, including elevated cardiac and liver enzymes. With these clinical presentations and evidence of organ dysfunction - was I septic? I never thought about it, but reflecting back, I presented with the signs of sepsis. I needed fluid, I had pulmonary, cardiac, and liver dysfunction, and I required hospitalization which means I met the definition of sepsis.
The steroids did wonders. My appetite returned. I was able to wean down the oxygen from 3L to room air. My exercise tolerance improved to the point where I could shower without too much trouble. After the week, I felt stable enough to go home. I paid privately for home oxygen in case I needed it.
At home I still had shortness of breath requiring occasional oxygen, bad chest pain and body aches, diarrhea and the headaches that I just couldn’t get under control. I continued to get tested every three days until I finally had a negative test- a month after my first symptoms. I could finally hug my kids and leave my room. I had to push past an irrational fear that even though the test was negative I still might be contagious. I returned to work, probably way too soon. I worked five hours and then had to leave. I was so tired. Now, another month later, I can finish a whole shift, but it’s not easy. Walking from the parking lot is hard. I’m not even attempting a flight of stairs. The headaches finally subsided.
I would never have predicted that I would be someone who could develop sepsis from COVID-19. I have no idea what the end of this illness looks like because I haven’t gotten there yet. I am thankful that my experience was not as bad as many others; I survived. Sepsis awareness month is a great time for healthcare providers and people everywhere to remind ourselves that with every infection we need to ask “could this be sepsis?” and be thankful for the healthcare providers who take care of us.
The Solving Sepsis program is addressing the entire continuum of care of a sepsis patient – from early pre-hospital interactions with healthcare providers, through hospital care and discharge – seeking innovative interventions at each step to identify sepsis early, address clinical management in order to improve patient outcomes and decrease mortality. Solving Sepsis is partnering with industry, academic and nonprofit groups to develop the following products to address sepsis.
It's important to prepare for sepsis in any emerging infectious disease. Learn more from our partner, Sepsis Alliance in their recent webinar.