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August 20, 2020

The Worst Patient—A Physician With COVID-19

Author Affiliations
  • 1Department of Otolaryngology/Head & Neck Surgery, University of Minnesota Medical School, Minneapolis
JAMA Otolaryngol Head Neck Surg. 2020;146(10):891-892. doi:10.1001/jamaoto.2020.2435

Physicians are accused of being the worst patients. Some of us wear that label with a perverse sense of honor. We think it means that we have unparalleled dedication because we can see patients while dehydrated and sick, because we can operate while febrile and exhausted, and because we sacrifice our own needs by putting our responsibilities to patients first. To us, there is no greater humiliation than to be thought of as weak. I have missed fewer than 2 weeks of work in 30 years, and most of that was a result of a ski lift accident, 2 long operations, and a lengthy recuperation. And I was proud (okay, I still am proud) that I operated 2 weeks later with that broken leg and ankle, and the patients did well.

In March 2020, I was trying to balance an increasingly crazy world. I lost my brother-in-law to glioblastoma. I had recently become interim chief executive officer for the University of Minnesota Physicians (Minneapolis, Minnesota). We were bracing for the coronavirus disease 2019 (COVID-19) surge that New York City, New York, was experiencing and that we knew was coming. I was part of the incident command center that met daily (in person) to discuss personal protective equipment shortages, intensive care unit capacity, and how to access ventilators. We were planning to open one of the first COVID-19–only hospitals in the country. When I left the incident command center at night, the financial losses and impending salary reductions meant difficult conversations with department chairs and other leaders every evening.

On a Sunday in late March 2020, we had completed respirator fit testing for a new mask prototype in a volunteer group of surgeons, many of whom were friends whom I had asked to volunteer. Although the test was not successful, the engineers felt they were close, and I returned home that afternoon feeling energized. When I developed a cough later that day, I attributed it to forgetting to refill my asthma medication. And the slight chills after dinner were clearly from being a little more tired, so I went to bed a little earlier than usual.

The next morning, my temperature was 100.9 °F, and when my toothpaste did not taste right, I realized that I had anosmia. I knew I had the virus and was worried about the surgical colleagues I had tested the morning before. I therefore presented for COVID-19 testing at one of our parking lot sites. I happened to pull up next to a surgical colleague from the command center, and we laughed wryly. We said that the tests were done quickly so we could get back to work. (God forbid we be weak.) That afternoon, I learned my swab result was positive. I alerted my colleagues (remarkably, none of them had positive results, probably because we were mostly masked).

Over the next 2 days, my cough worsened and my temperature rose to 103.2 °F. I had trouble breathing and my wife and sister said I did not sound right. But I convinced myself that I was fine. My organization needed me in a time of crisis and I was not going to back down with just a fever and shortness of breath. But my colleagues could tell I could not finish a sentence, and I looked terrible on the screen. I ignored their suggestions to seek help. Fortunately, several of my trusted colleagues turned into “informants” and called my wife to express their concerns. One whistle-blower even sent a finger oxygen saturation monitor to my wife. Annoyed, I put it on just to show my wife I was fine. It read 86%. I remember thinking it had to be wrong and explained to my nonclinician wife that actually, 86% was quite good, as it was almost a B+.

But spouses always know when you are untruthful, and Teresa got me to the university emergency department. I made my case to the attending physician, whom I happened to know, and told him that I was fine to go home. He responded by putting me in an ambulance to the new COVID-19 hospital that we had ironically opened that week. On arrival, I told the attending physician that I just needed a good night of sleep. He conducted lung ultrasonography and pointed out all the unusual B lines that he saw and administered oxygen to me. I remember thinking that he was a well-meaning young attending physician and I would just get some sleep and leave the next morning.

Of course, I was not better. My breathing worsened and my saturations fell. I could barely move 500 cc on my incentive spirometry on my very best efforts. Another attending physician soon mentioned intubation as a next step. My liver function test levels were up, my D-dimer levels were elevated, and I required more and more oxygen. I was already participating in a hydroxychloroquine study and joined a remdesivir trial. The worst symptoms were the nightmares every night. I could not describe them in the morning, but I came to dread the evenings. I attributed it to the hospital and I resolved to be discharged as soon as I could. I got up to a chair as much as possible and tried to stay prone when in bed. I did as much deep breathing and painful coughing as I could. But I was still not convinced that I was really ill. I told my wife over the phone that I was fine. Remarkably, my apparently whispered pants of feeling fine did not alleviate her worries. I even hurried my oxygen wean by turning my oxygen flow down a little from time to time. Yes, a couple of nurses got upset with me for being a bad patient, but hey, my saturations were always above B+. Finally, on day 11, I was allowed to go home. The original attending physician, who was superb, said it would take 4 to 6 weeks to recover. I secretly scoffed. I figured it would maybe be 4 to 6 days before I was back.

It is almost comical in retrospect. A couple of weeks after I got home, I could still barely walk without sending my pulse soaring. Yes, I had gotten rid of the oxygen, and the nightmares had gradually receded, but I certainly was not back at work yet. I was told that the clinicians who had COVID-19 were all back at work. For someone who never missed work, I was devastated. Why was I taking so long? I feared everyone would think that I was weak and that their new chief executive officer was undependable. So, I returned on a Monday. I joined calls, read compensation proposals, and helped with state and federal applications for COVID-19 funding. And I was completely exhausted by Tuesday and became really ill again. But why, if everyone else was fine? I felt I was losing my mind. Remarkably, 2 weeks after discharge was the first time that I took the disease seriously.

My increasing frustration, damaged ego, and self-doubt were rescued by candor. First, I learned that 2 of my colleagues from the command center who were back at work were in fact trying to hide their exhaustion. One was the colleague who was tested on the same day I was. He had not been as sick as me at first and had tried to work for several weeks. But he had elevated troponin levels, a lipase level of 1370 U/L (to convert to microkatals per liter, multiply by 0.0167), and pneumonia. We connected; he realized that he needed to rest and I realized I was not alone. Then, another colleague who had contracted a serious COVID-19 infection a month before me detailed his prolonged and still ongoing recovery. Learning that others had to struggle as well was a huge, unexpected relief. I gave myself permission to disengage from work completely and to focus on rest. It was like magic. In 2 weeks, I began to recharge. I returned to work after 4 weeks, and now after 6 weeks, I am just about back at full strength. Four to 6 weeks. Just like the doctors said. Had I listened.

I recognize now that I am no different than other patients when I am seriously ill. A degree in medicine, or a job as a physician, does not allow me to heal faster or to ignore advice. Never mind the larger issues of whether we are delivering the best care to patients when we are ill. But more immediately, in the effort to appear effortless, we may worsen the spirits and confidence of colleagues. I can say with certainly that my spirits and confidence were shaken not just by the disease, but by a fear that somehow I was weaker than my colleagues.

But the big lesson has been understanding the heartache I caused my family. Not only did my wife and children contract COVID-19 from me, but I was unaware of how they felt. My sister, who had just lost her husband, and my wife were terrified. I learned that they sobbed every night on telephone calls while I was in the hospital, fearing that I was next. My insistence that I was fine made it worse because they did not know if I was disconnected from reality or if I was being honest with them. Neither gave them confidence.

My wife has since told me that they were so frustrated with me that they could not wait for me to recover completely so they could give me a piece of their mind. So, I suppose I am a little reluctant to tell them that I am completely recovered. But it is probably good that I will not go completely back to my old ways.

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Article Information

Corresponding Author: Bevan Yueh, MD, MPH, 420 Delaware Street SE, MMC 420

Minneapolis, MN 55455 (byueh@umn.edu).

Published Online: August 20, 2020. doi:10.1001/jamaoto.2020.2435

Conflict of Interest Disclosures: None reported.

Additional Contributions: I thank all the persons in this article for granting their permission to publish this information.

4 Comments for this article
Thank you
Shannon Tupper | Beautiful and heartfelt. Will share w/ those who need to see the depths of the condition. Thanks for making it OK to recover!
I just wanted to thank the author. Brave move to share...and it will help others!
Physician Heal Thyself!
Arvind Joshi, MBBS MD; FCGP FAMS FICP. | Founder Convener and President: Our Own Discussion Group; Mumbai, PIN 400028; Consaltant Physician at Ruchi Diagnostic Center and Ruchi Clinical Laboratory Sunshine CHS, Sector 21 Kharghar PIN 410210.
This comment is not to deride the author but only to say that Doctors too are human beings. They too need healing touch. That healing touch may be provided by oneself, by family or friends or on a few occasions the doctor's too may need Professional help. There is no shame seeking appropriate help. Recently Leaders of NHS Trusts in United Kingdom had expressed concern about mental and physical health of their staff. One of the NHS TRUSTS is said to have deployed psychologists to help their staff.
Post-CoVID-19 SYNDROME, some call it Long CoVID-19, some call it Post-acute CoVID-19;
call it by any name one pleases, it is for real and there to stay for long. The CoVID-19 Pandemic is leaving bodies and minds scarred which will take long to heal.
Post-infection chronic fatigue syndrome, Fibromyalgia, Cardiomyopathy, Central and Peripheral Nervous System involvement are no new entities. Doctors contracting the infections they are treating also happens not infrequently: Tuberculosis is one such case.
Due to enormity of the CoVID-19 Pandemic, it's infectivity, the Multi-system involvement it causes and profound Sequelae it evokes; the Post-CoVID-19 Syndrome is going to be a massive burden in coming days. It is going to affect common people and DOCTORS ALIKE.
And who else but the DOCTORS themselves can heal the DOCTORS?!
Arvind Joshi;
Founder Convener and President:
Our Own Discussion Group,
602-C, Megh Apartments,
Ganesh Peth Lane, Dadar West,
Mumbai, PIN 400028;
Consaltant Physician at Ruchi Diagnostic Center and Ruchi Clinical Laboratory, Sunshine CHS, Plot 58, Sector 21, Kharghar, PIN 410210;
Maharashtra State, INDIA.
Delightful essay
Bobby Jacobs, MD | None
"86% was quite good, as it was almost a B+" that is funny!
Thank you
Randal Otto | University of Texas Health Science Center
Bevan-You're honesty and humility are again reflected in this publication. This, among other things, are why you make such a wonderful leader.