The ability to exam patients nowadays is supremely limited due to virtual conferencing platforms being used more and more to see patients in our office. My office is now different. We hear so much about death on social media sites, the news, and in readable periodicals that we forget that some of our patients who contracted the novel coronavirus live. Not only do they live, but they also survive. And in primary care, we are ever so fortunate to establish care and follow-up with them after home quarantine or hospitalization in the time of the pandemic. These are examples of their stories. Patient 1 My conversation with her was the most memorable. She was elderly, in her seventies and African-American. Our visit was telephone-based without any face-to-face time even virtually; therefore, I’ve never met her. I don’t know what she looks like, but I can hear via our conversation that she seems to be a truly wonderful person. She followed up with me after a nearly weeklong hospitalization. There was a concern that her daughter may have brought the virus home to her unknowingly, and her sister was on another phone in the house. She sounded strong. She sounded resilient. Both of them, really all three of us, audibly gave praise to God that she survived. Other family members could have been exposed, including the sister, and there were a few questions about that. She was my first patient who I knew of who tested positive for the COVID-19. She was also the first patient I ever directly was involved in caring for who survived. She was the first for me, personally and professionally, in so many ways. I shared that with both her and her sister. They, oddly, didn’t have a lot of questions. She was also found to be slightly hypertensive during her hospital course but was doing well with medication and dietary practices that were recommended during her hospitalization. We all laughed when she said to me, “Well, doctor, I guess I’m your number one.” I jokingly agreed. She will follow-up soon to have a repeat chest radiograph in four to six weeks. She had a right lower lobe pneumonia. I encouraged her to complete all antibiotics as prescribed. Patient 2 She’s in her late thirties. She is believed to be a Type A personality. She was the first I diagnosed in the office by direct nasopharyngeal swab. She is African-American and leads several teams at her place of employment. Her presentation was now classic: presumed exposure to someone at her company, remarkable upper respiratory symptoms, muscle aches, cough, and no documented fever, but there was subjective fever. At the time, we didn’t know, in screening these patients, much about the loss of taste or anosmia. I didn’t ask about these symptoms, and she didn’t offer. She just remembers the profound shortness of breath. She was relatively healthy, with the exception of a history of anxiety and mild obesity. Her swab returned positive five days after I performed it, outside of the promised forty-eight to 72-hour window. I immediately called her. I sent her for a chest radiograph. We caught bilateral pneumonia just in time as it was starting to develop early, and I prescribed her antibiotics. She was able to remain out of the hospital and was encouraged to continue self-quarantining at home. She was anxious but also relieved. I can feel her concern. She recently followed up after completion of treatment, and another chest radiograph was done. Her pneumonia is gone. She is better and almost finished with her recommended fourteen-day quarantine at home. She has questions about should she be retested to ensure that she is no longer infectious before she returns to work. I have those same questions. She is having persistent gastrointestinal symptoms, but fortunately, no cardiovascular sequelae of the disease. I urge her to bear with the medical community and me as we learn more and do more to prepare her for any longstanding complications of the disease. My charge to her was to keep her updated as I am updated. She asked how I was doing, and for that, I’m grateful. Patient 3 The last patient never had a conversation with me. She was asleep and resting. Her mother and I talked because she has a developmental delay due to Down’s syndrome. She is in her mid-30s, African-American, and was discharged after testing positive for COVID-19 on supplemental oxygenation. The majority of the virtual conversation was about measuring her oxygen level, how long she would necessitate supplemental oxygenation, and the target levels to achieve on room air as her bilateral pneumonia continues to resolve. She has allergies per her mother, and we discussed ways to treat them with antihistamines and intranasal corticosteroids. I also educated her mother on ways to protect herself. I offered home health. She declined at this time, given “all that is going on.” The patient was hospitalized for approximately eight days. She received fluids and antibiotics, and improved. Her mother, it is evident, takes very good care of her and is deeply concerned about her, but is confident that she has everything she needs to care for her daughter, including purchasing a home oximeter to check her oxygen level that just “had not arrived yet but was on the way.” I offered within the confines of medical treatment and care our services to help her along the way and in developing a plan for follow-up and repeat chest imaging in four to six weeks after completion of her antibiotic course. I told her mother I look forward to meeting the patient one day. She smiled and agreed. These are stories of overcoming, perseverance, and survival. These patients are epitomes of strength and resolve, and now more than ever, we, as physicians, are their students and are learning from them to extend care and treatment to others to provide for similar outcomes of survival. So many have died. These lived. Earl Stewart, Jr. is an internal medicine physician. Source
