All of my experience and training have ingrained into me that a patient with an oxygen saturation in the 80's needs to be on a ventilator. Thinking back to my internal medicine day, I could not recall a single instance where a patient with this kind of sudden drop in oxygen was actually alert and talking to me. I could sense my team members' impatience as they waited for me to give the order to intubate. I knew what I was supposed to do, but I kept thinking back to something that a doctor in Italy said to me on a Zoom call the previous week.
Before COVID19 exploded in the United States, I had been speaking to a colleague in Italy. The type of cosmetic treatments that I had become very involved in was using stem cells and regenerative medicine to help people look younger. This is a new field so I had been collaborating with like minded doctors around the world and sharing notes. On a conference call the previous week, the conversation was no longer about stem cells. The Italians were warning us of the dire situation they were in with COVID19. They did not have enough ventilators so they were having to make the awful decision of choosing who they were going to save and who they would let die. Hearing the stories and sensing the desperation in their voices, I knew that it was only a matter of time before we were in the same situation. It was like getting a sneak peak two weeks into our own future.
Knowing what was coming our way, I made the painful decision to lay off my employees and close my non-essential cosmetic practice a week before Governor Murphy made it mandatory. When the call came for doctors and nurses to help man the COVID field hospitals, I felt that it was my obligation to step up even though I had not treated a sick patient in over a decade and I was afraid that I may be more than a bit rusty.
As a cosmetic surgeon, I was seriously questioning my ability to keep my COIVD-19 patient alive. I had switched from regular medicine to cosmetics in 2007 so I had not even been near a sick patient in over a decade. What was I even doing here? Then I came to the harsh realization that NOBODY knew what was they were doing. Not the “experts,” and definitely not the politicians who were sending us conflicting information. I was the doctor on duty that night and having been in real-time contact with my Asian and European colleagues who had several more weeks of experience with this crisis, I told myself that I had to know a little bit more about this than most of the doctors in the United States. Our doctors were coming face to face with this novel corona virus for the very first time and the virus was like nothing we had seen. It was breaking all the rules.
I remembered the Italian doctor saying that one thing that seemed to help was putting the patients in a prone position. It sounded hokey and seemed unlikely that turning him onto his stomach would make a difference but I had nothing else to offer and at least it couldn’t hurt. “Let’s turn him over.” I said. And everyone looked at me like I had two heads. All except for one respiratory therapist who looked at me wide eyed with excitement.
“Yes, I heard that’s a thing. They are doing it in Europe!” Rebecca, the respiratory therapist, exclaimed. Once Rebecca spoke up, it was like a switch being turned on. Everyone was on board. We turned him over and almost immediately, his oxygen level stabilized at 85%. This was a very scary number. Normally, the patient would be turning blue but his color remained stable and the number did not drop any further. He was still breathing very rapidly and could only string together about three words at a time but the oxygen level stopped getting worse.
“Pulmonary toilet.” Amy yelled out and immediately, Rebecca started pounding on the back of his chest. After a few minutes, the oxygen saturation started to go up. 89%, 90%. We all cheered and George, feeling better, but still lying face down, put his hand up and everyone gave him a high five. Growing tired, Rebecca stopped percussing his chest for a moment and the oxygen level started to dip down again. One of the other nurses who had been standing by jumped in and resumed the beating and the oxygen saturation started going up again. The whole team took turns all night gently drumming on his chest as George lay face down all night long. I even took a couple turns and when our shift ended at 7am that morning, George was able to lie on his back and his oxygen saturation level was back up to 96%.
What an incredible night. I had not forgotten how to take care of sick patients after all. It all came back to me but in the end it wasn’t even my medical skill that saved the patient. It was the compassion, trust and teamwork of the incredible people who were with me that night.
I’m glad to be back at my cosmetic medicine practice now where nobody dies and all my patients are happy. The medical doctors who are taking care of the sick COVID19 patients now have a better handle on how to keep the death rates down. Part of the new standard of care is to avoid putting the patients on a ventilator and to put them in a prone position. Exactly what we did that night with George.
I now wonder. “was I just lucky that the decision that I made that night turned out to be the correct one? Or was it because, even as a cosmetic surgeon, I was keeping up with the cutting edge of medical innovations and having contacts around the world that helped me to transfer my instincts to this situation and ultimately make the correct decision?” I like to think it was the later and of course the incredible team of heros who were working with me that night.
On a related note, I am very excited to report that the stem cell therapies that my collegues and I have been working on for cosmetics are being seriously looked at as potential treatments for long term effects of COVID19 as well as for other medical chronic conditions. I feel truly blessed to be able practice what I do in such interesting times!