Author + information
- Lori B. Croft, MD∗ ()
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
- ↵∗Address for correspondence:
Dr. Lori B. Croft, Mount Sinai Heart, Mount Sinai Medical Center, 1468 Madison Avenue, New York, New York 10029.
Lying in bed with covers nearly suffocating my face and head in a futile attempt to alleviate my chills, beads of sweat trickling down my face and a temperature to 102.9°F, I never imagined feeling this ill or experiencing such emptiness. I was alone and sick. The deep burning sensation in my chest and shortness of breath was relieved only when my attention refocused on my severe myalgia. In my feverish moments, I imagined myself being rushed to the hospital, my emergency department colleagues eager to assist me but hesitating for fear of contracting my illness. Then my mind was racing: how would I even get to the hospital, as I had sent my family away to a safe haven so that I would not infect them? I was suddenly alone and abandoned. Doctors do not call for help; they are the ones who provide help. I was isolated and nearly paralyzed by my fears and physical ailments. My high fever induced an altered mental state facilitating fear and loneliness and overwhelming any rational medical thought. Finally, when the fever broke with an antipyretic, my thoughts cleared and I realized that after all those days in the front-line trenches of the coronavirus-2019 (COVID-19) war, I was now one of its victims.
To put my narrative in appropriate perspective, let me take you back 11 weeks before I became ill, when COVID-19 first hit New York City. Like many other physicians, I was quite anxious and troubled over what the nebulous future could hold. We were hearing reports from Europe of both patients and their physicians dying at alarming rates. As physicians, we can be jaded by statistics of death and doom. Then when our floors were overwhelmed by the COVID-19 onslaught in its first days, I encountered death in intensive care units, on the wards, in our emergency department. However, as physicians, we draw a hard line of separation between what happens to patients and what happens to “us.” Physicians are supposed to be invulnerable, or so our patients and family think. But as reports rolled in of numerous health care workers becoming ill and dying, I had to acknowledge my own mortality. COVID-19 was infecting people of all ages, some more vulnerable than others. I became quite fearful of my risk for contracting the disease and the risk I posed to my family. I therefore sent my family away so that I would not endanger their well-being.
I was then determined to engage the vile disease that was ravaging our ranks. As a director of a high-volume echocardiography laboratory in New York City, I was not sure what to expect within my hospital walls. As patients started to flood the hospital, we soon learned how extremely ill these patients were. Many presented with multiple-organ involvement. A significant proportion of patients presented with chest pain, hypotension, electrocardiographic changes, and biomarker evidence of myocardial injury, which prompted requests for transthoracic echocardiography (TTE). Quickly we were inundated with requests for TTE in patients with COVID-19. Initially, my appreciation of the impact TTE can have on patient care balanced by my staff’s apprehension of exposure to these patients generated a rational approach: TTE should be performed only if the results would provide an immediate clinical benefit resulting in a change of management of the patient. As a well-seasoned echocardiographer, I spent hours on the phone convincing requesting physicians that TTE was unnecessary. Then I received a request to perform TTE on a physician stricken with COVID-19. She was having chest pain and shortness of breath with increasing biomarkers. She was my age, with no comorbidities. I felt like I was suddenly seeing my reflection in the COVID-19 mirror. As I evaluated this situation and the many other similar requests, I realized that many physicians needed clinical guidance in the care of these sick patients by a cardiologist, and some patients actually would benefit from TTE. But then I faced the challenge of how this service would be performed, and by whom, as operators would thereby expose themselves to contamination.
As I discussed with my sonographers the urgent need to perform TTE on selected patients, I quickly saw fear and trepidation in their eyes. Many of these sonographers I have known for more than 10 years. They are more than employees; they are my family. In an act of solidarity, I created a system in which we entered patients’ rooms together: physician with sonographer. To lead by example, I accompanied the technician into the patient’s room for the first 80-plus echocardiographic examinations. We would dress in full personal protective equipment, check each other to ensure that we were appropriately covered, and enter the room with a pre-determined plan for the study. During the initial examinations, my head sonographer, Samantha, who accompanied me to all our initial cases, and I were full of apprehension and unease. However, as we became more acclimated and comfortable with the process, I soon discovered that we were providing more to these patients than merely a diagnostic test. My limited time in the room became a long-awaited and desired visit for these patients. I was providing prolonged human contact, which these patients were missing. During the early weeks of COVID-19, many health care workers were very apprehensive to enter the rooms of infected patients, which resulted in limited human interactions for these isolated and depressed patients. I realized that our performing TTE was changing that. After cautiously entering the room, we introduced ourselves and explained the purpose of the visit. The sonographer was in direct physical contact with the patient, placing the probe on the patient. As the reading physician, not only did I enter the room to ascertain that the images were diagnostic and search for an intravenous site to inject ultrasound-enhancing agents (echocardiographic contrast), I took a few moments to speak with each patient (even a monologue for intubated and sedated patients), ask about their emotional health, retrieve objects out of their reach, help reposition them in bed, plug in their phones, assist in calling loved ones, or even just hold their hands. Many patients were intubated and could not speak but communicated and emoted with their eyes. Others tried to communicate while on bilevel positive airway pressure or wearing a facemask. It was difficult to hear them, and I was initially very fearful of moving close to their faces to hear their barely audible words. However, their desperation to communicate was so overwhelming that any fear of aerosolized virus left my thoughts. I had my personal protective equipment armor. I would be protected; I was the invincible physician warrior.
Patients with COVID-19 would express their deepest thoughts to me: their loneliness, their fear of being abandoned, their pain or discomfort, or, most distressing, their fear of dying alone. One indelible memory I have is of a 72-year-old Hispanic man in a COVID-19 unit. His wife had died of COVID-19, and he himself was dying. Because of his comorbidities, he had given instructions that he was not to be intubated or resuscitated. He was agitated by his bilevel positive airway pressure mask, and his oxygen level would episodically desaturate into the low to mid 80s. As we performed TTE, he thanked us. He spoke of the comprehensive and compassionate treatment his wife had received. He told us that his wife had made his life meaningful and complete. He was not bitter or resentful but resigned to his fate and ready to rejoin his wife. His equanimity and faith resonated with me. Although I had always considered myself a thoughtful and compassionate physician, my interactions with these isolated, unfortunate COVID-19 victims taught me a new level of empathy and compassion. The transthoracic echocardiographic study may have helped with patients’ care, but my 15 to 20 min in their rooms helped in their emotional well-being and healing.
My experience with patients with COVID-19 came full circle when I contracted the disease 11 weeks later. I was isolated and vulnerable, suffering alone, seeing my family’s concern and tears on FaceTime only. My illness induced a fugue-like state, depression, and extreme fatigue, resulting in limited communication with them and other concerned friends. My prolonged illness, manifested by very high temperatures and multiple somatic symptoms, crystalized my understanding of the extreme isolation and desperation my patients had experienced.
Now fully recovered and back to work, I am not the same person I was 3 months ago. I am much better for my experience and have an enhanced appreciation for what we all take for granted too often: the gift of good health. Although I remain traumatized by the COVID-19 tragedies and my own personal experience, I hope I have become a better doctor and human being because of it.
The author has reported that she has no relationships relevant to the contents of this paper to disclose.
The author attests they are in compliance with human studies committees and animal welfare regulations of the author's institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Case Reports author instructions page.
- 2020 The Author