At the end of February Dr Ryan Padgett's colleagues in the emergency room called him over to share some news: a patient who had died the previous day had tested positive for coronavirus – the first known death in the United States.
Everything, they knew, was about to change. Over the next several days a parade of patients from a nearby nursing home was brought into the emergency room at EvergreenHealth in Kirkland, Washington, which emerged as the first centre of the United States’ coronavirus outbreak.
The patients were in dire condition, struggling for air. But most of them were old, and some were already sick. Padgett did not worry much for himself. The 45-year-old physician kept in shape with gym visits and skiing trips. Back in college, at Northwestern, he had helped lead its American football team to the Rose Bowl after the 1995 season. In 21 years on the job, almost all at EvergreenHealth, he had taken only five sick days.
Padgett's case offers a harrowing window into the risks faced by front-line medical workers and the devastating effects coronavirus can have on some people who are otherwise healthy
Then, one day in early March, he felt a headache coming on, which was unusual for him. His muscles were sore. By March 9th he had a fever and a cough. Two days after that his breathing was so laboured that he realised he was going to become a patient in his own hospital. “Either this thing is a beast or I’m just not used to being sick,” he texted a friend. “My Ironman immune system failed me.”
Padgett was one of the first two emergency-room physicians in the US to be hospitalised in intensive care with coronavirus. His case, which he shared publicly on Monday for the first time, offers a harrowing window into the risks faced by front-line medical workers and the devastating effects that coronavirus can have on some people who are otherwise healthy.
For Padgett, who hovered at one point near death in a medically induced coma, it took medical teams at two hospitals to bring him back from the brink. Back at his home in Seattle, still weak from his three-week ordeal, Padgett describes an illness that left him feeling as though he had, for the first time in his life, utterly lost control.
Even before he learned he had coronavirus, he says, he knew this was no ordinary case of the flu. “You can’t lay flat, or you start gasping for air,” he says. “A couple of steps forward and all of a sudden it’s like you just ran three miles, which is pretty rare. I’m in pretty good shape. You knew something was up. You knew something was different.”
The turnaround time for a coronavirus test at the time was at least several days. Assuming that he had the illness, Padgett stayed home with an oxygen monitor. Even as his condition continued to worsen, Padgett says, he was in a bit of denial, assuming that things would be fine. His fiancee, whom he was set to marry in May, questioned him after his oxygen levels began dropping well below normal levels. He responded by saying that maybe the oxygen monitor, not as good as the ones in the hospital, was faulty. “She looks me in the eye and she said, ‘Okay, I’m going to get ready to go to the hospital. We’re going to take one more measurement, and if it’s too low, we’re going.’” Within hours Padgett was on a ventilator.
His colleagues at the hospital put him on the antimalarial drug hydroxychloroquine, whose effectiveness for coronavirus is still unknown, but Padgett’s condition continued to worsen. By March 16th his heart was struggling, his kidneys were failing and his lungs were not providing enough oxygen to his body. The levels became so dire that he was on the verge of suffering oxygen-starvation injury to his brain.
Indicators of inflammation in Padgett's body were 'astonishingly high', suggesting that he was potentially dealing with a dangerous 'cytokine storm'
Padgett's team at EvergreenHealth decided to transfer him to cardiac specialists at Swedish Health Services in Seattle. Dr Matt Hartman, a cardiologist there, says it was clear that Padgett's condition was rapidly worsening and that if they did not do something he would not survive.
“We didn’t know if this was someone who was just going to die no matter what we do,” he says. “We think with his age, and the fact that there’s no other major comorbidity or problem, that we should at least give it a try.”
The team decided to hook Padgett up to a machine known as an ECMO that could essentially serve as both an artificial heart and lung, taking his blood out of his body, oxygenating it and returning it to him. Although such procedures are most often done in the surgery suites, in this case it was all done in the intensive-care unit, to prevent spread of coronavirus elsewhere in the hospital.
"We brought the operating room to him," says Dr Samuel Youssef, a cardiac surgeon at Swedish. The team also began consulting oncologists. Indicators of inflammation in Padgett's body were "astonishingly high", suggesting that he was potentially dealing with a "cytokine storm", a dangerous phenomenon in which the immune systems of otherwise healthy people overreact in fighting coronavirus.
The doctors administered the drug tocilizumab, often used for cancer patients who can have similar immune-system reactions. They added high-dose vitamin C after seeing reports that it might be beneficial. These experimental treatments had also been tried on another patient, a 33-year-old woman, with some success.
During that week in mid-March there were signs of improvement. As his inflammation numbers came down and his lungs started to provide more oxygen, the team began scaling back the ECMO machine, until they finally removed it on March 23rd. Four days later the breathing tube was removed. Slowly, after two weeks in a sedated coma, Padgett began to wake up.
'When I went to sleep, things were pretty normal, and you wake up and they say, 'You know, people aren't leaving their homes and everything is shut down"
It took him a couple of days to begin gaining awareness. At first he did not understand where he was. The unfamiliar view out of his hospital window left him wondering if the top of the Space Needle, the city’s landmark observation tower, had been turned into a Covid-19 unit.
He had missed a lot. While he had been unconscious, government mandates to contain coronavirus had altered life for everyone else. “When I went to sleep, things were pretty normal, and you wake up and they say, ‘You know, people aren’t leaving their homes and everything is shut down,’” Padgett says. His wedding, he learned, might have to be rescheduled.
Padgett says he has been humbled by the care he received and alarmed at the destructive capabilities of the virus. “It goes from kind of initially feeling like this was a flulike illness where the vulnerable are the ones that are going to get sick, and now understanding that the vulnerable are getting sick and there’s going to be some young, healthy people that get cut down with this,” he says. “That’s the scary part. I think of my colleagues still on the front lines. That’s what I fear for them.”
Padgett says he is still working to recover physically and mentally. He worries now about whether he will regain full cognitive function, noting moments of memory and attention problems. Still, he says, things have improved each day. During the next two or three months, he will be doing physical and occupational therapy. After that, he plans to return to his job, despite a new perspective on the risks. “As an emergency physician, you walk into every single room and take care of whatever is there,” Padgett says. “Going back, I don’t think that will change. I hope not.” – New York Times
