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coronavirus, COVID-19: This photo was taken the day Dr. Rotkowitz was exposed to COVID-19 despite the PAPR he wore. He had intubated multiple patients that evening.
FigureA few months ago, I never thought I would contract a virus that could take my life, but recently I had to deal with COVID-19 that I caught from a patient.
I had been assigned by the emergency department director to the March 28 overnight tour of our newly assembled hot zone. It was my job to direct and provide care for the sickest patients who came through the door. The powered air-purifying respirator (PAPR) that I strapped around my waist felt so foreign to me, and it made me feel distant from my patients. I said goodbye to a colleague who had covered the day shift, and found myself alone in a micro-epicenter of COVID-19.
I was worried that I might be infected, but all my experience and training had not prepared me for this. The virus unleashed its fury right before my eyes, and it completely crippled the operations of the emergency department. Exhausted, I struggled to maintain my role as team leader. Days later, I began experiencing symptoms after another exhausting overnight shift. By April 1, I was officially offline: SARS-CoV-2 was dismantling my physiology.
Slow Recovery
My quarantine at home began immediately. I had debilitating symptoms the first week that worsened as days passed. My body aches increased every day, and I lost my sense of taste and smell. Sleep offered no relief; even my dreams were filled with feverish nightmares. By the morning of April 8, my oxygen saturation levels were becoming concerning. My breathing was starting to become labored, and my body was experiencing an unprecedented level of stress. Later that morning, a concerned friend came to check on me and found my oxygen saturation level at 78%. I was admitted to NYU Langone Medical Center that afternoon in critical condition, requiring specialized high-velocity nasal insufflation.
Figure: New York City Fire Department EMT Gregory Hodge, who died from COVID-19 on April 12.
Throughout my 10-day hospital stay, I struggled to comprehend the course of events. I had sacrificed countless hours of studying, training, and dedication for my career, but now my personal safety hung in the balance. I was worried that I might need mechanical intubation. I had witnessed many serious COVID-19 emergencies, and I knew what to expect—I feared for my life. Knowing that intubation often leads to death, a new frightful reality stood before me, but I had every confidence in the members of the care team at NYU Langone. Everyone was concerned, compassionate, and caring. That made this terrifying experience much easier.
I was released from NYU Langone two weeks later requiring supplemental portable oxygen. I expect to be restored to a decent level, but I find myself exhausted and unable to concentrate on any tasks as I write this a month after first experiencing symptoms. As fragile as things seem, I strive to make small recuperative steps each day. The hospitalization left my body weak, and my mental acuity is far from as sharp as it was before my infection.
While I recover physically, my spirit remains crushed as I mourn for my patients and lost colleagues, like Lorna Breen, MD, the medical director of the emergency department at New York-Presbyterian Allen Hospital, who died by suicide on April 26 after treating many COVID-19 patients. I will fondly remember New York City Fire Department EMT Gregory Hodge, 59, who died from complications of COVID-19 on April 12. He was a 24-year veteran of the FDNY, a commercial pilot, and a survivor of 9/11.
New Way to Live
I have no idea what the ultimate effects of the coronavirus will be upon my body. Obviously, I am hoping for the best, but long-term health consequences are possible. My emergency medicine colleagues are already transitioning to other specialties. Some of them have begun moving away from New York. Returning to a full-time emergency department schedule is questionable. This experience has truly made me aware of how important my master's in public health is in this new world. The accidental combination of my illness, the circumstances surrounding it, and the educational path I have taken have certainly brought me to a defining juncture in my life.
The COVID-19 pandemic will likely bring about fundamental changes in all workplaces. Hospitals and all health care facilities are going to be financially pressured while enduring the loss of experienced staff due to fear, illness, and exhaustion. As this health care crisis moves past the first wave, survivors in pandemic hotspots will reevaluate their definition of work. I never envisioned that things would turn out like this. Healing includes processing the devastation and sadness that I witnessed and the role I played in all of this.
Figure: Dr. Rotkowitz's chest x-ray on the day he was admitted for COVID-19.
This pandemic will be the ultimate influencer in how we interpret our daily existence and future goals. Dealing with it has made me reexamine my career and look toward a new definition of each day. My new five-year career goal will be about finding happiness and stepping into a healthier lifestyle. These defining moments of my career now lie before me.
Dr. Rotkowitzis an emergency physician in Queens, New York.
