The COVID-19 pandemic will forever mark my first year as a hospitalist. Despite the familiarity of working at the same hospital where I recently completed residency, my first week on the COVID team was full of trepidation. I vividly recall one of my initial admissions from these early days.
A very healthy young male with controlled asthma presented with exacerbation symptoms. At this time COVID results took days and there was minimal evidence-based medicine available. Even though the consulting pulmonologist was not overly concerned about the patient's respiratory status, I weighed the benefits of knowing the results sooner than later and ordered a chest CT.
I was stunned by the results, demonstrating central bilateral pulmonary opacities resembling a “haunted face-like” pattern. The patient was immediately admitted to the COVID rule-out floor, and when the test results came back positive he was transferred to a negative pressure room.
A few days later, I was assigned to round on the COVID team. Garbed in full PPE gear, as I prepared to walk into that patient's room all I could visualize was the poignant “face-like” images from his CT. It was my fifth COVID room of the day. I took a deep breath and entered.
The patient was on high-flow nasal cannula and talking to me in intermittent short sentences while maintaining oxygen saturations. He seemed stable, but prior to my departure he asked to use his bedside urinal. When he sat down on his bed, I immediately begin to hear the monitor beeping. Even though the patient said he felt all right, his oxygen levels had dropped into the low 70s with minimal activity. He was visibly tachypneic, trying to take deep breaths. After five to 10 minutes, when his saturation only slightly improved to the low 80s, it was now evident he required intubation.
To me, this was COVID-19 showing its ugly “face” as a formidable virus that is difficult to manage. Fortunately, after one month of mechanical ventilation, the patient was able to be weaned from the ventilator and was discharged from the hospital.
In the months following, early diagnosis of COVID-19 became the standard of care and rapid-response tests were developed. This will be the patient encounter that defines my front-line experience during the COVID pandemic. The clinical challenges paired with the evocative radiological images allow for a vivid memory of the “face of COVID.”