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From the Heart
August 12, 2020

Having Coronavirus Disease 2019 (COVID-19)

Author Affiliations
  • 1Icahn School of Medicine at Mount Sinai, New York, New York
JAMA Cardiol. 2020;5(10):1091. doi:10.1001/jamacardio.2020.3247

“This is weird,” I told my colleague, describing my heart racing at 130 beats per minute when I woke up in the mornings. After recovering from a mild coronavirus disease 2019 (COVID-19) illness, I was excited to return to work in the intensive care unit (ICU). But after a few days, I knew something was wrong. Having seen patients who recovered from mild COVID-19 illness subsequently deteriorate and require intubation, I worried about ending up like them. Working was the magical way to put these thoughts away; if I could be taking care of the patients with the most severe illness, then I could not be one of them.

I direct an ICU in New York City, New York, a center of the COVID-19 pandemic. We treated a continuous wave of patients, tragic situations of young and old, patients with respiratory failure, shock, strokes, pulmonary embolism, and kidney failure. Before COVID-19 arrived, I felt invulnerable, not yet aware of the power of this virus. We would be okay because we were protected by our personal protective equipment. I was also protected by my white coat. When I started medical school at Columbia University in 1981, all physicians and students wore white coats and I have worn a white coat every day since. Although current generations have discarded the white coat, the white coat is defining for me as a physician and as the person who is not a patient. So I was less afraid for myself, but I was terribly afraid of bringing COVID-19 home.

While working on a Sunday in the ICU, I noticed that I did not taste my lunch, lunch that the ICU nurses lovingly prepared to feed and care for the team. Then, after developing cough and fever, I had a positive test result for COVID-19. Being home and away from the work of the ICU was difficult. As a physician, COVID-19 is the medical challenge of a lifetime and I needed to be in it. I had to turn over the daily management to trusted colleagues and still try to keep up with the constant information and decisions. It was frightening to know about the dangers of COVID-19 and so I checked my saturation, tried to sleep in prone position, and hoped that I would not worsen.

As soon as I was cleared to return to work, I rushed back to the ICU. However, after a few days, I felt worse, sensing that my heart rate was going fast even when I woke up. But I could not maintain the pace in the hospital, I could not breathe with my N95, I could not even stand for rounds. I walked into the echocardiography laboratory and as I watched my echocardiogram, I could see that the wall motion was not the vigorous contraction that it should be. The cardiologist showed me all the views demonstrating that my ejection fraction was decreased. My physician suggested admission for telemetry monitoring but I declined. I imagined what it would be like to be admitted to a telemetry floor, to hear the overhead pages for the rapid response team and medical code team that my own team responds to and wondering if that call was for me. I did not want to be isolated, as the hospital now did not allow any visitors. I dug out my completed health care proxy form and placed it in my bag, just in case. I was sent home to monitor my vital signs and with the instruction to rest and avoid stress, an impossible prescription for these times.

There at home, I experienced my body, strength of my pulse, the depth of breathing. Although still involved in the daily work in the hospital, I could not endure hearing the television news about what COVID-19 was doing to the people of the city, the daily death toll, the overworked health care workers, and the stories of families grieving. I listened to the daily 7 pm cheers from New York City neighbors. As a lifelong New Yorker, the daily cheering/honking/clapping in honor of health care workers was a surprise and a true lift to the spirits. Someone was writing loving messages on the hospital sidewalk to the health care workers. My hospital colleagues and leaders all checked in and encouraged me to take my time to recover. The symptoms of chest tightness gradually subsided and, fortunately, the echocardiogram and laboratory parameters improved.

What were the lessons of a relatively mild case for this physician-patient? COVID-19 is really, really tragic, worse than we could have ever expected. I experienced what it is to feel one’s body, the difficulty of a breath, a fast heartbeat, the vagueness of feeling unwell and the fear it brings. This is what patients experience on a daily basis. No one is safe from illness. COVID-19 reminded me of the miracle and fragility of a healthy body. Isolation of patients is painful to observe and to imagine for oneself. Our humanity is sustenance in this crisis: working together, caring for each other, hearing neighbors’ cheers, and providing kindness to patients and families even from a distance.

Of course, the magnitude of the losses continues to overwhelm: the sheer number of more than 100 000 deaths in this country, including so many health care workers. I still cannot taste my food. But I completed my stress echocardiogram, achieving 3 stages of the Bruce protocol, and I feel better than ever.

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Article Information

Corresponding Author: Janet M Shapiro, MD, Mount Sinai Morningside, Department of Medicine, S&R13, 1111 Amsterdam Ave, New York, NY 10025 (janet.shapiro@mountsinai.org).

Published Online: August 12, 2020. doi:10.1001/jamacardio.2020.3247

Conflict of Interest Disclosures: None reported.