Dispatch from Seattle, v9: My uncle has been in the hospital for two months with COVID
Dispatch is new column on life from inside the Seattle-area experience of COVID-19. It’s meant to offer insights into what other regions of the country can plan to experience as the wave of COVID rolls into their community.
Eight weeks ago, my uncle went on a ventilator a result of COVID. He hasn’t left the hospital yet.
But he is still fighting, and it ain’t over.
The struggle against COVID has taken a new turn for my family. We knew my uncle’s challenge with COVID would be a marathon rather than a sprint. His care givers prepared us well. But, we had no idea how long that marathon might really take.
This story is meant as a follow up on my first article about my uncle’s trials with COVID as he entered his fourth week on a ventilator. It’s meant to share one family’s experience dealing with COVID.
On the four week anniversary of my uncle’s intubation from COVID, he came off the ventilator for good.
To get there would be a multi-step process that started with detox.
Having him in a medically induced coma for four weeks required that he was given significant doses of drug combinations. These ranged from antibiotics to keep infection at bay to opioids and narcotics for pain and to slow his system.
Bringing him back to consciousness would first require getting him off some of these most impactful drugs. Dealing with withdrawals while conscious would complicate his re-awakening. So, getting him off some of those in a step-down manner came first.
Over the previous week, he had flirted with coming off the ventilator. He would spend a few minutes at a time without the help of the machine, but would quickly be back on. As days moved forward, a few minutes started to stretch into a few hours until ultimately the ventilator was ready to be out completely.
The ventilator had been at 90-100% for much of his time in the hospital. It was now down to 40%, the lowest level it would go.
Physicians said they believed his lungs were getting stronger. They were ready to extubate him. But he would need to wake up first. And, that was taking longer than the physicians liked.
Early in his venitlator experience, my uncle had a collapse of his blood oxygen levels. A combination of mucus buildup in his airways and fluid build up in his lungs plummeted his O2 levels to the 70% range for hours.
That was the kind of thing that we knew could cause some level of brain asphyxia. How much would be a question that could only be answered during recovery.
As we waited each day for progress reports about his care, we knew that he may not return to us the way we once knew him. Going down to 70% blood oxygen saturation could result in a wide range of complications, with the worst possibilities to include that he may never wake up.
In the third week of his stay, he remained COVID+. The bug was holding on to him.
Each day demonstrated a little more lung strength, however. And, in the fourth week, as his strength began to grow he finally got his first negative test result.
He had beaten the disease. Now, he had to recover.
And the next step was waking up.
Four weeks after going on a ventilator, almost to the hour, my uncle started to wake up and was extubated.
One of the physicians said he was on a ventilator longer than anyone they had had in the hospital. And, given the difficulty my uncle was having breathing, there was a 50% change he would have to go back on one.
His daughter was able to FaceTime with him for the first time in almost a full month.
He was groggy. Eye contact was hard to hold. He couldn’t speak, but lip movement might have suggested he tried to say “I love you, too” at the end of the call.
Throughout the preceding four weeks, physicians had been very good about explaining what was optimistic and what was realistic about my uncle’s prognosis.
Now, they were as eager to see how well he would recover as we were. This was unchartered territory.
A COVID+ patient with four weeks of intubation. What would his process through recovery look like?
In those first days, the steps were small but the wins were huge.
He was clearing his throat. He was miming the nurse by sticking out his toungue. He would sometimes lift his hand an inch off the pillow. He would lick his lips.
One day he would seem to be able to focus for a few minutes. The next he was mostly asleep, unable to engage during short FaceTime calls.
A test for COVID was taken, and another, and one more just to confirm. He had three negative tests, meaning the physical therapist could start to work with him.
It also meant that he could move from the critical care unit to a recovery room.
He was on his way back.
At the start of the sixth week, my uncle could say “Good morning” as the nurse entered to check on him.
He was getting context, time, and understanding relational queues.
An MRI showed no significant brain damage. There were some pinpoint strokes that appeared to have happened as a result of COVID, but those weren’t anticipated to be problems.
This was really good news, as it allayed the worst case fears.
The PT had him sitting up, on the edge of the bed. This would help with some core muscle strength, something that had deteriorated significantly over the preceding weeks.
The next big test would be to see if he could swallow anything. And, if he could swallow, could his body keep it out of his lungs.
For a few days, they started feeding him ice chips, which he liked. But, it took about four days for him to really be interested in doing the work of swallowing and eating beyond the ice chips.
The physicians were ready to take out the feeding tube installed six weeks ago. My uncle was starting to pull it out as he slept, so they outfitted him with mittens to limit his tactile abilities. They were ready to remove the tube, but he needed to be able to eat on his own first.
A barium test was set to see if he could hold it all together. By feeding him a little applesauce, loaded with barium, the hospital could watch the barium as it worked through his gastro-intestinal track. If it stayed out of his lungs, he would be good and the tube could come out.
Luckily, it was a test he passed with ease. That meant that more real food was on its way. He started with french toast and a vanilla milkshake.
As weeks seven and eight in the hospital conclude, the wins remain incremental: good humor returning, a recognition of faces and family, more intentional conversation.
It looks really good from here, like the worst fears have been allayed.
The road to recovery will be a marathon, not a sprint, just as the physicians said.
I didn’t know it would be an ultra-marathon, however. If you’re a distance runner, you know what I mean.
At some point in another few weeks, my uncle will need to transition to a skilled nursing facility. He will need speech and occupational therapy to support his physical therapy. He’s lost over 60 lbs and will need to regain basic muscle memory and strength.
It may be three more months before he can go home. No one really knows.
But, he is still here, he is on the road to recovery, and he may have his name in the COVID record book before it’s all done.