It was about a week before the chest x-ray. We were on laps when the nurses called us into his room and yelled through the closed door. From outside the room, I took in the bright red blood in the ventilation hose and in the suction container, the oxygen saturation fluctuating. We moved quickly to stabilize him while one of the local doctors called his family to come in. It was the first time in a month that they had seen him in person, as the rules of the time said family members could only enter if a loved one could die.
We met the son and his mother in the hallway to help them put on personal protective equipment. I turned the boy around like a surgeon in the operating room and tied the yellow dress tightly behind his back. He had brought flowers to say thank you. His mother was silent, holding a small prayer book that we had helped her slip into a biohazard bag. The boy put his arm around her, a gentle gesture of protection. We all entered the room together. I remember explaining to them that the ulcers on my patient's face were on his chest, that the tubes in his neck and groin should remove his blood, and have it run through a pulmonary bypass machine. The son nodded as if that information made things better. His mother prayed and I told them we would do whatever we could.
After more than three months, my patient is finally home. He doesn't remember anything from the intensive care unit. When he made it out of the hospital and into rehab for the first time, he was shocked to learn that April had turned to June and believed he had had a catastrophic car accident, asked his wife what happened. She told him it was better not to know too much, and he took those words to heart. Now his scars are fading, but he tries to sleep at night, awakened by vivid nightmares of his childhood. His son notices that he is now more forgetful. He inventories how his body has changed. A patch of skin on his left thigh that he has lost feeling on, a pain in his shoulders and chest, the tip of his finger blackened from insufficient circulation. In rehab, doctors told him it might need amputation, but over time it looks like it could be saved.
There in the clinic room, I remember the nurses turning his head toward Mecca and bathing his body in holy water his family had deposited in the hospital lobby as I listened to the air flowing into my patient's remarkably clear lungs. and poured out you thought he might die. I remember how we could even hear the religious music from an iPad in the room from outside in the hallway. No matter how many times I return to those moments, I still don't know what to make of them. Its result is enormous, one of our best achievements, a survival that we did not expect and that we still cannot fully explain. A father is back with his family. He will feel the pride to see his son enter college, even if he is from afar. But there is something bittersweet. His eyes are haunted and he cannot sleep and I have no idea how or when he can get back to work. His son hears sirens go by their house on the way to a nearby hospital, and it's like everything is starting all over again. As much as I want to assure you that everything is fine, I cannot promise such a thing.
At the start of the pandemic, it was easy to see mortality as the only outcome that mattered. It is certainly the easiest to measure. Almost six months later, we are still focused on coronavirus-related mortality as an indicator that the situation in this country is finally improving. But it is becoming increasingly clear that mortality is not the whole story – for either of us. People want to be able to go back to their lives and know what might lie ahead. Yet there are still more questions than answers. We continue to learn about the long-term effects of this virus. We don't know how strong and how long the immunity is, or what therapies actually help improve outcomes. We don't know how many of those who survive severe Covid-19 return to work, the extent to which the lungs heal, how often patients are re-admitted, the level of exposure to psychiatric illness, and the long-term consequences of isolation. We don't know why my patient was the only one in his family who got so sick and why he was better.