On the COVID rule-out floor, we developed an internal “covidometer” to guide which patients' positive tests we would believe, which we wouldn't, and which level of care was looming. When an emergency medical technician named Diane was admitted, her covidometer rating, unfortunately, was ominous. A sinking feeling accompanied review of her CXR, labs, and comorbidities. She received remdesivir, steroids, convalescent plasma, anticoagulation, moral support. Despite these, her oxygen needs steadily increased. Proning was not going well. It was plain she would best be served in the ICU. Diane, as an EMT herself, knew that too.
But she looked us in the eye, adamant. “This is a mental game for me now,” she said. “You send me down there, I will not make it. You will keep me on this floor, and reassure me, and I will make it.” There was no reassurance to offer; instead, goals of care were re-hashed. But Diane was persistent. “Look, I'm not going down there. I control bipolar with an hour of yoga every day at home. I will get through this if I focus.” Which is how, after an emotional call home, her yoga bolster joined us in the room, as did her private yoga teacher, via iPad.
With Diane proning more comfortably on her home bolster in child's pose, with high-flow oxygen cannula at its highest settings, yoga was the new treatment plan and her yoga teacher now squarely the attending in charge. Diane cautiously tried out a twist on her back, still on highest flow. We stayed in the room, terrified she would code. She talked us through what she was doing, joyful as the ubiquitous dry COVID cough turned productive for the first time mid-twist: “That stuff is coming out! I knew it!” Her oxygen saturations rocketed north.
She worked up to several hours of yoga per day in various permutations on the hospital bed in isolation. She informed everyone who entered how COVID, and any illness, was best approached yogi-style. The team dubbed her the COVID Yogi. At one point panic ensued when her nurse saw her motionless (corpse pose, she apologized, when he raced in). Her demonstration of the Breath of Joy—a most aerosolizing of maneuvers—was truly an inspirational pandemic moment.
Now at home, Diane has given a virtual talk to medical students on the mental game and yogic focus she knows saved her.
A 2020 Cochrane review suggested modest benefit from yoga in asthma, and others have suggested possible benefit in COPD. Yoga and yoga breathing techniques are deserving of further investigation in respiratory illness. Happenstance brought yoga successfully into a negative-pressure COVID room. The COVID Yogi is a reminder to the medical community that yoga is a powerful tool, valuable in maintaining well-being and coping with acute and chronic threats to health. Perhaps all the more so in the midst of an isolating pandemic.