I spent about two dozen nights in the hospital this year — fewer than usual, because I took some time off to recover after spending three of those nights admitted as a patient. It wasn’t Covid, thankfully. In March I underwent an emergency operation for ovarian torsion (night 1), and in October I gave birth to a healthy baby boy (nights 2 and 3).
People often ask me what it was like to deliver a baby in the midst of the pandemic. The short answer is everything was smooth; there were no problems at all with the delivery. But in other ways this year has been wild and enlightening as I’ve navigated these unprecedented times as both a doctor and a patient.
The early days were the scariest
On a Saturday morning in mid-March, I was playing at home with my two preschool aged kids, worn out after spending the night as the on-call general surgeon. I couldn’t get relief from an aching pain in my lower abdomen. I felt miserable. Finally, I drove myself to the emergency department, and long story short, that evening I consented to an emergency operation that would un-twist my ovary and restore its blood supply.
This was in the earliest days of the pandemic. I couldn’t have visitors in the hospital. I wore a mask, although it wasn’t enforced. We didn’t know how the virus was transmitted back then. Looking back now, it seems like people were taking every precaution except the right one.
I had to call in sick for my two upcoming ICU shifts — my first time ever calling in sick to the hospital. Of course my colleagues understood and filled in for me, but I felt guilty. Our ICU in Santa Clara County was filling up with Covid patients. I couldn’t do my part.
My surgical team provided great care and I was able to go home the next day. I felt fortunate that my surgeon was the same OB/Gyn who had delivered my daughter three years prior — I experienced first-hand the importance of knowing and trusting your surgeon. With all due respect to my fellow surgeons, I really never wanted anyone going into my abdomen, but when it had to happen, I’m glad it was Gary Hoff.
The next week was hard. I suffered from ileus for the first few days, which means my intestines were stunned by the operation, not moving. I know this condition intimately as a general surgeon — if the person eats or drinks, nothing moves downstream and it all backs up. I felt the nausea, hunger, and headache from caffeine withdrawal that my patients have felt all these years. The nausea was even worse because I was about 6 weeks pregnant at the time and had to take hormone replacement therapy during my first trimester to make sure everything went ok with the pregnancy.
The week after my operation was also the first week our company started working from home. While I struggled through my recovery, my colleagues at Suki, the tech start-up where I lead product management, each individually faced the dislocation and fear of the early pandemic.
About two weeks after surgery, at the end of March, I drove down to the hospital for an overnight call in the ICU. We were all cooped up in our homes under shelter-in-place, and I remember feeling a happy sense of purpose as I pulled out of my garage. I claimed a regular size N-95 mask and an eye shield, and spent the night placing arterial and central venous lines for the ICU team. The unit was full of Covid. Going room to room on evening rounds, we had a near-identical conversation for most patients. The yellow contact isolation gowns could be found on almost every door on both ICU floors, all marking Covid patients, most of them on ventilators. We were throwing the proverbial kitchen sink at many of them. I remember giving special attention to a Covid-negative liver failure patient, concerned that others might miss her subtle signs of clinical deterioration as they focused on fighting severe viral pneumonia in all the others.
There was no remdesivir yet. We would get the drug early, as part of a clinical trial, and then under a compassionate use exemption. The data on dexamethasone was yet to come, and steroids were reserved for last-ditch efforts in the sickest patients. We didn’t have protocols around the use of high flow oxygen, and I remember a heated exchange with nursing about whether a patient’s high flow settings were putting staff at risk by aerosolizing the virus in the patient’s room. We also didn’t understand yet that the virus could cause potentially deadly blood clots. I distinctly remember attempting to place an arterial line in a very sick patient, only to find both radial arteries clotted off. I eventually had to put the line in the larger femoral artery.
After that night, I took a break from patient care for more than a month. The hospital cancelled all elective surgery, and my surgeon colleagues became relatively idle. Since I only take part time call, I decided not to take shifts (I spend the majority of my time at the tech start-up). I told my department leaders that if they needed my skill set to save lives in the ICU, I would help, but short of that I was medically high risk and wanted to sit things out.
Over time, we settled into a new normal
When I returned for my next general surgery call in May, it felt like a cautious business-as-usual. The rest of the world didn’t feel that way, but the hospital did. Some changes were minor: A temperature check at the hospital entrance added a few minutes to my commute time. The salad bar was gone from the cafeteria. Also, significantly, the need for personal protective equipment (PPE) governed all the mundane rhythms of hospital work.
The biggest change from the early days of the pandemic was we assumed Covid was everywhere. The virus was spreading in the community by respiratory route. In June, California mandated face masks for everyone. The CDC additionally required healthcare workers to wear face shields.
The new normal involved scrubs and PPE locked up in an equipment closet behind the OR front desk. I had a pass code to the room. If I needed an N-95 mask, I had to ask the OR charge nurse, who would retrieve it from an even-more-protected stash.
My preferred face shields for operating were (and still are) on back order, so I had to wear goggles that fog up and dig into my forehead. During one particularly strenuous case, I looked up from the open abdomen and asked the circulating nurse to please remove my goggles which had fogged over completely so I couldn’t see. My familiar Friday night scrub tech joked with me, “You do look pretty intense doc.”
In the OR we yelled to hear each other through the shields, masks, and CAPR hoods. When two surgeons wear CAPR hoods, they would constantly butt heads over the open abdomen. The residents cut off the bottom of their face shields because they kept contaminating instruments handed to them.
Greeting patients in a mask and face shield still feels awkward. When I was heavily pregnant, I had a hard time catching my breath on rounds after walking up stairs. The PPE made those rounds incrementally more uncomfortable as I sucked on the paper mask with each inhalation and my face shield fogged. But then, I would often walk into a patient room to find the patient not wearing a mask. The risk of exposure nagged the back of my brain.
In the ICU, we fell into a routine as a novel standard of care emerged for treating Covid pneumonia. Surprising elements of our protocols included early use of steroids, and a maneuver called self-proning, where awake patients position themselves face-down in bed so that gravity can help the lungs absorb more oxygen. This helps stave off intubation for as long as possible. A blood thinner to prevent clots became another part of the regimen. As patients got sicker, the path of escalation was as I would expect for severe pneumonia.
A truism of critical care medicine is that codes always seem to happen at shift change. One afternoon, my colleagues were halfway through handing off their patients to me when our sickest patient, a woman with pneumonia but two negative Covid tests, suddenly arrested. Her whole picture looked and smelled like the virus, and she had a repeat test from a deep tracheal sample pending. I was eight months pregnant and my colleagues stepped up to run the code, telling me I could sit it out if I wanted to avoid exposure. When I went in the room to help, in full PPE, the solicitous nursing staff passed me a second face shield. The patient died of a massive pulmonary embolism, a blood clot in her heart and lungs. Minutes after we called the code, her new Covid test came back positive.
My son was born at the height of the pandemic
In October, under the care of the same Dr. Gary Hoff, I checked myself into the Labor and Delivery ward to start induction of labor. As the L&D nurses walked through their intake procedures, I watched them adjust their N-95 masks and peer through fogged face shields. I empathized with these minor discomforts — worth it, but still annoying.
The hospital tested me for Covid using a deep pharyngeal swab and the negative result came back within two hours. After that, I took off my mask, and the staff abandoned their N-95s in favor of regular paper masks. It’s interesting how each hospital has implemented a different policy. This hospital, unlike the Santa Clara hospital where I work, tests every admitted patient for the virus.
My delivery was happy and uncomplicated. I had a brief reunion with a colleague from residency who placed an excellent epidural (I don’t like pain). My husband was allowed to be with me, and he could come and go as needed to care for our two bigger kids at home. The big kids weren’t allowed to see the baby in the hospital, but when I was discharged, they came along in the car to pick us up and meet their brother for the first time.
That’s how my most recent tenure as a hospital inpatient ended. From the viewpoint of a patient, I saw the minor annoyances of the Covid protocols adding up and wearing down the resiliency of those caring for me, and I saw a reflection of myself in that. I didn’t feel any need for them to appear superhuman, and realizing that made me give myself a bit of a break. I also appreciated the peace of mind bestowed by routine Covid testing of all hospitalized patients. I hope when there is enough testing capacity, this can become standard everywhere.
Now I’m home on maternity leave. I’m all healed up from the operation earlier in the year, and Dr. Hoff did such a nice job that I barely have scars to show for it. I’m grateful for the skillful care I received as a patient, but I’d rather not be hospitalized again anytime soon.
Now, again, Covid cases are surging and our Santa Clara ICUs are filling up. Again, I hate to sit it out. But it’s different this time. We know the signature of the disease. We know how to give patients their best chance of survival, and we know how to protect ourselves. I’ll be back on the wards early next year, slogging through these next few hard months. And then someday soon, the pandemic will be just a memory.
