“Babe, I wrecked your car.”
“What are you up to?”
“Les, I wrecked your car!”
“What? You’re not serious, are you?”
“I think I fell asleep,” I said. “I hit the center median cable barrier.”
A long pause.
“I am OK,” I said. “The puppies are OK, too! Your car … not so much. I need you to come get us.”
That’s the conversation I had with my wife after falling asleep driving down Interstate Highway 40 at 4:30 in the afternoon. I had gone to buy a baby carrier so we could take our two mini-schnauzers, Cookie and Harley, with us on rides. I fell asleep and hit the cable barrier at somewhere between 75 and 80 mph. I don’t remember for sure.
What I am sure about? I took out 10 cable barrier support posts and totaled my wife’s recently paid-off Ford Edge. By the grace of God, neither the dogs nor I were injured. On reflection, I have come to an intriguing realization about guardian angels—my guardian angels, the Marines I once served with. I firmly believe my Marines are now on liberty, tasked to ensure I make it home alive.
“Alive” is relative.
“Why did you fall asleep at the wheel?” “Why were you so tired?” “Were you just getting off shift?” “Had you been up all night?” All valid questions, asked ad nauseum. My answer: I shrug my shoulders. It’s a pitfall of being a juggler, front and center, in the largest ongoing three-ring circus in the world—the Covid-19 pandemic.
In March 2020, The War Horse Journal published “The Circus Is Coming to Town,” a reflection of my thoughts, concerns, and musings regarding the emerging Covid-19 pandemic through the lens of a newly minted physician assistant. I wrote about my concern that the ER would become the epicenter for Covid-related care, which would lead to frontline medical staff contracting the virus. At the time, the novel coronavirus was thought only to be a concern for the elderly, or for those with comorbidities, such as diabetes, obesity, and respiratory disease.
During all of this, I was overweight at 240 pounds with a diagnosis of occupational asthma from my time in the service. I feared I would not fare well when—not if—I got sick. I tried to deflect it by not discussing it. I was—still am to a degree—scared shitless. I fear nothing more than suffocating, which is an excruciating way to go out, and it’s exactly how many Covid patients are dying.
It was a Tuesday, the second day of August 2020, when I got the message that everyone in the world dreads right now. My phone rang unexpectedly, the number showing the doctor’s office. I dropped the F-bomb.
This can’t be good.
“Johnnie, it’s Donna,” I heard. “You have Covid. Sorry …”
For the previous five days, I had felt like a freight train broadsided me, like my bones had been filled with lead that my muscles couldn’t support. I never had a temperature or cough, nor did I lose my sense of smell or taste. Just felt horrible. Two days prior, I had tested negative at a local urgent care.
I’m good, I thought, naively. I’m just tired. I was, after all, in the middle of an emergency medicine fellowship. I learned, the hard way, the tests cannot be completely trusted; they had a significant number of false negatives. Translation: If you tested positive, you had Covid; if it showed negative, wait a couple of days and do it again. (They’ve gotten better: The “gold standard” test is considered 95% accurate.)
I was on the second day of my trauma rotation at a level one trauma center working for a director with high expectations who was not afraid to remove part of your backside if you failed to meet those expectations. Having to go tell her, with the proverbial hat in hand, I had potentially exposed all my coworkers as well as, worse, the patients to Covid was not a stellar moment in my new emergency medicine career.
After calling my medical director, then my wife, I headed home to self-quarantine. The 40-plus mile drive home was excruciating. I beat myself up for possibly exposing my patients, colleagues, and family to what had been, for many, a deadly nightmare. I knew too well the effects of self-imposed guilt from the loss of my Marines 25 years prior and the toll it had taken on me, mentally and physically. Selfishly, I didn’t want another 25 years of guilt associated with the death of friends or family.
I did not expect a 12-day psychological rollercoaster of ups, downs, and extreme lows. We were nine months into the pandemic, and the world had seen millions of COVID infections, including patients I had personally treated. I knew it was not the initial three to four days of being sick that mattered, but rather how well you fared during days eight through 12 that predicted your ultimate prognosis. During this period, if a patient develops shortness of breath associated with an oxygen saturation percentage of less than 90%, they are admitted to the hospital, alone, without family; if it gets worse, people say their goodbyes on Facetime.
In March 2020, I treated a man who died in the first hour of my shift. His wife died before it was over. Another shift, I stood in the parking lot of the ER with my attending while he explained to an 88-year-old man that his wife of 66 years, mother of his five children, had suffered a stroke and needed to be transferred to the main hospital. Due to the then-newly imposed visitor policies, they wouldn’t be able to say their goodbyes, nor he to visit her if she reached the hospital. The anguish, the hurt in his eyes, the pain on his face, the fear of losing her will forever be imprinted in my memory.
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It affected me so much that when I witnessed close family members going about their daily routine as nothing was going on, I lost my mind. I expressed my thoughts with explicit four-letter words to reinforce my disdain for their perceived lack of respect and situational awareness. Their actions had potentially fatal ramifications not only for them, but for the health care workers tasked with their care.
“If you get sick,” I said, “you are going to die—and die alone!”
During my quarantine, I experienced difficulty breathing. It felt like an asthma attack, and I constantly needed my inhaler. I did breathing treatments every three to four hours. I constantly checked my oxygen saturation and my temperature in fear of the fever I never developed. I avoided sleep because I feared I would wake up and not be able to breathe, or, worse yet, not wake up at all. It had been years since the demons came in my sleep, but they returned with a vengeance. I would wake up in a panic, ripping off my sleep apnea CPAP machine, heart racing like a quarter horse running the last furlong, drenched in sweat, truly afraid of dying. I worried about who would take care of my wife, my dogs, my mom, my siblings, make sure the grass was mown—the little but important details that make up our daily lives.
I struggled to find a coping mechanism. The pandemic had shut down the veteran support groups. My counselor at the veteran’s readjustment center was overwhelmed and ended up with Covid herself. I couldn’t really talk with my coworkers; I was the first of our team to get sick. I bottled it up, pushed on, and embraced the suck.
But I had more going on when I wrecked my wife’s car.
Prior to getting sick, I had been training for a Spartan race—foot races that include obstacles. I worked out the stress of my fellowship, the pandemic, family, and everything else through fitness. I completed a virtual Super race the week before getting sick, running more than 10 miles in one day.
But after Covid, I could not run a quarter of a mile. The day before the wreck, six weeks post-Covid, I hiked in the Wichita Mountains. I climbed Elk Mountain, a three-plus-mile trip with a 570-foot elevation gain—did it twice while wearing a 50-pound pack. Not very smart, I know. As a result, I had my first personal encounter with what many Covid patients are experiencing: PEM or post-exertional malaise. PEM happens 24 to 48 hours after activity.
After the hike, I was exhausted. I had taken a three-hour power nap prior to the wreck. In retrospect, I should have pulled over and taken another nap, as I’ve done in the past. Kept telling myself, Just a few more miles and I’ll be home. Falling asleep while driving was a wake-up call, communicating loud and clear that I needed to do things differently.
Covid is no joke.
The threat continues to be real. The enemy is at hand. The “Delta strain” is not some political stunt, it’s real—and it’s hitting young, healthy people hard. It spreads fast, just in the amount of time it takes to walk past someone in a hallway. I worry what the fall of 2021 will be like. I was scared, am still scared, of dying, but I’m more afraid I’ll fail my patients.
Old wounds I thought I’d healed have re-festered. Long-buried memories of my self-perceived failures—I should have saved my Marines—have returned front and center, along with the result of the associated stresses of being a frontline health care worker.
The long-term physical and cognitive effects associated with Covid-19 have yet to be determined, and we haven’t even begun to discuss the silent mental health injuries. Covid-related suicides, depression, and worsening chronic disease—including among health care workers—have drastically increased as this pandemic drags on. Hospitals are once again filled to capacity with the Delta strain patients.
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The majority of people with Covid will experience minimal issues. But for those known as “long haulers,” the future remains uncertain. At the time of this publishing, it will have been a year since I contracted Covid. I have received my vaccine shots, and for those wondering about being chipped … well, you’re really not that interesting.
I have been working out five to six days a week. In February I completed the “Taji 100,” where I ran or hiked 100 miles within 28 days. I completed my EM fellowship and started working at the same level one trauma center mentioned earlier. I am excited about what my future holds.
But I know the future will look different.