The 5 Stages of COVID-19: As Told by a NYC Resident Physician

Neha Gupta MD

Lenox Hill Hospital, Internal Medicine PGY1


May 15, 2020

New York, New York

1. Denial (March 25-30)

Body aches, fatigue, excessive sleeping… all of those symptoms had to be from being overworked, right? I was entering week 4 of 4 in the medical intensive care unit with only 3 days off in 22 days! Two of those weeks had involved caring only for patients suffering from the novel coronavirus. Our hospital was blessed with sufficient PPE and a wonderful support system, so how could I have contracted the virus at work? I was adamant that I was burned out and just needed a day off from work to catch up on my significant sleep deprivation. After sleeping at least 20 hours, taking Motrin for my body aches, and foam rolling the heck out of my muscles, I geared up to return to another day in the MICU. I worked that Friday, almost normally, and told myself I was okay – ignoring the muscle aches and mild fatigue that persisted. I went home that evening and ordered dinner in with a friend who was also working on a COVID telemetry unit.

The first of many temperature checks.

I went to sleep that night relaxed and happy that I had another day off to further rest and recuperate. Saturday morning I woke up still feeling tired and ache-y, which was odd. I continued to relax and doze for the remainder of the day. My sister, a pulmonary-critical care fellow in PA, thought it was unusual for me to still be tired after catching up on sleep for over two days by this point. She didn’t voice her concerns yet, however, simply told me to continue taking it easy. By that evening, my aches had worsened and I started to feel chills – I took my temperature and to my dismay it was 99.1°F. To be fair, that’s not a fever, but it’s also not a “normal” temperature for a healthy 27-year-old that had been working in a MICU overrun with COVID. My options were: continue to tough it out until it truly presented itself, listen to my body and call out sick for work the following day and continue to monitor my symptoms, or be smart and call out sick to avoid exposure to other individuals and go to an urgent care center to get tested. In choosing the last option, I was sure that I would assuage my (and my family’s) fears and provide myself with an answer within a day or two, allowing me to return to work knowing that I was just burnt out.

Worst swab ever experienced.

2. Acceptance (March 30-April 1)

After being swabbed, I was told to self-quarantine, continue checking my temperature, and to expect test results in 48 hours. During this time period, I continued to have fevers up to 100.5°F in the evenings. On Monday, the day I was waiting for my results, I was feeling a little better and hyping myself up to return to work. Speaking with my co-interns, I was acutely aware of how busy the hospital was and how necessary it was for me to return to work. I was certain that my test results would be negative, but I called Urgent Care that evening and was greeted by a kind nurse on the other end of the phone. After going through the usual questions (name, birth date, etc.), the nurse placed me on a brief hold and a doctor returned to the line – “Dr. Gupta, I’m sorry to tell you this but your results were positive for COVID-19.” The rest of the conversation was a blur, and I finally understood how patients feel when they get medical news that they are not expecting. I vaguely recall being told to notify employee health services and to isolate for 7 days and only to return to work after that period as long as I had been asymptomatic for 72 hours. I video called my parents, immediately, nervous for their reactions. “I love you daddy, I’m positive”. My dad was initially confused by this declaration and I watched as understanding set into his face. My mom was not surprised at all; she already knew it would be COVID. I was the only one in denial. My mom told me they were prepared for this news and that my sister had discussed with them the likelihood of being infected. I notified my chief residents and co-interns and prepared to buckle down at home, ready to fight the battle of a lifetime. This was the beginning of what was arguably one of the most heart-warming experiences of my life. Friends, family, colleagues, fellows, attendings…everyone started reaching out, offering Tylenol, groceries, food, and emotional support.

The declaration that changed me from physician or patient.

I lost my sense of taste on March 31, something I didn’t notice until I tried to eat some ice cream. My energy levels were decreasing and my appetite diminishing, as I tried to find higher calorie options for nourishment. Looking back, I don’t even know when I started to lose my sense of smell – such a strange symptom that a large number of COVID patients suffer from.

I continued to rest at home, napping, video calling family, and sometimes watching TV. As I mentioned before, my sister is a pulmonary-critical care third year fellow at the cusp of graduating to attending status. Her husband is a gastroenterology third year fellow as well; both, usually incredibly busy and minimally available. During this time period, PA had not been hit as hard and their hospital had requested they work from home until needed in the hospital. Because of this, they were video calling me multiple times a day to check in on me. My biggest cheerleader to health was my five-month-old nephew, who would join in on their video calls and giggle with me for what felt like forever.

One of many "cousin" zoom sessions.

3. Fear (April 2-5)

As family and friends continued to shower me with love, surprising me with packages of gourmet popcorn, chocolate truffles, and food deliveries, I continued to worsen. I watched as my muscle aches gave way to a persistent cough and higher fevers along with a new intermittent sensation of lightheadedness and anxiety. I had never chosen to invest in a pulse oximeter, a portable device that measures the amount of oxygen in your body (normally 98-100% in a healthy individual). A wonderful friend offered to drop hers off at my door so that I could assess my body’s oxygenation and monitor for the clinical deterioration I so feared. My baseline saturation at rest at that point was 94-95%, a surprising awakening.

On Friday, my cough was so severe that I could no longer talk without setting off a coughing spell. My PCP’s office happened to call that morning to check on me, apparently they were notified that I had been swabbed for COVID – I thanked them profusely for checking in and asked for help with my cough and was told they would get back to me. As busy as I’m sure they were, I waited until 4pm for a call back, after which I couldn’t wait anymore. I contacted one of my attendings and explained that I was COVID+ and needed something desperately for my cough. I couldn’t imagine getting through the weekend with only my minimally helpful OTC Robitussin. He was a lifesaver and sent in prescription strength cough syrup to an amazing pharmacy that delivered the medication to my doorstep for free!

Alex, an angel clad in PPE.

Over the weekend, my fevers continued to worsen even on a standing regimen of Tylenol every 6 hours. Saturday evening my temperature hit a max of 102.5°F – I tried taking a cold shower to no avail and ultimately had to take the feared medicine, Motrin. My cough persisted and I started to experience some shortness of breath with activity, with my saturation dipping down to 92%. In the last week, I had transitioned to sleeping on my couch with 2 cushions, as I could no longer tolerate or find comfort in my bed. I also began video chatting my parents at night, leaving it on so they could hear if my cough was worse and check on me when they woke in the morning.

The turning point of my illness was on Sunday, when I woke up to a coughing spell and discovered my resting saturation was 88%. This was startling. I continued to nap throughout the morning. Little did I know that behind the scenes, my family was discussing the need for me to be evaluated in the ER. In the afternoon, I reached out to one of the pulmonary fellows at my hospital who recommended being evaluated. My best friend in residency turned out to be an angel – she insisted on coming to my apartment in full PPE to evaluate me. She noted poor inspiratory effort and crackles in the middle lobes of my lungs. I was scared and didn’t know what to do and she didn’t give me much choice. We were going to the ER.

Afraid but surrounded by friends in the ER.

4. Recovery (April 5-14)

In the ER, I had a chest X-ray done that showed bilateral pneumonia. Again, I was in denial and shocked that I had developed such a complication. I am 27 and have no significant past medical history, how could this be happening? Initially resistant to be admitted to the hospital, Alex and a wonderful ER physician assistant convinced me to stay for treatment. They noticed I was having difficulty speaking in full sentences and felt that my chest X-ray was worse than expected. Alex went above and beyond and called my sister and reasoned with her, explaining why it was important that I not go home. My sister agreed and called me, telling me it was time to let them take care of me. In that moment, a weight lifted from not only my shoulders, but also my family’s shoulders – they no longer had to constantly check on me and worry, I was in good hands.

Chest X-ray showing bilateral pneumonia from COVID-19.

I received the COVID-19 cocktail and remained in the hospital for 3 nights, after which my fevers resolved and my cough began to improve. It was interesting being on the other side of the hospital, as a patient instead of a physician. Though technically alone, I felt surrounded by family. The nurses were familiar, the attending on service was my residency mentor, and my co-interns and residents all checked in on me constantly. They brought me Gatorade and snacks and stories and smiles. My attending called my sister daily to update her on how I was doing. When it was finally time for me to go home, the nurses of the floor gifted me a “Thank You” note, covered in multiple heartwarming messages all telling me to hurry up and get better so that I could come back to work alongside of them, in a normal setting! What had once been “just a job” had turned into a family experience. Not once in my hospitalization did I feel “alone” or aware that my true family was not present.

Signs visible from the hospital.

When I got home, I nestled back into my makeshift bed and set up all of my “gifts” from the hospital – remaining medications and cough syrup. I caught up with family who cheered me on for being home. I spent the rest of this period sleeping 18+ hours a day, making up for my significant sleep deficit from the past couple of weeks. And I celebrated internally – I had made it back home, safe and sound.

Hospital discharge ready!

5. Guilt (April 15-19)

Wednesday was my first day truly “awake”, i.e. I didn’t sleep 18 hours! I had completed my isolation on Monday, but it was raining and I still didn’t feel like emerging from my safe cocoon. On Tuesday, I grocery shopped for myself for the first time in almost three weeks. I walked 1.5 blocks with my pulse ox on hand (ha!), walking slowly and deliberately, testing my recovering lungs. My saturation was 92-93% walking, not so bad, but my heart rate was in the 150’s – I was definitely deconditioned. Walking home with my groceries was a little more challenging than expected, and I was thankful for a break at the pedestrian walkway near my apartment. I was very tired afterwards and napped for a bit. The following day, I did laundry – I walked half a block to the building that houses our washer and dryer, a feat that required 3 trips in all to bring clean clothes home. I was significantly short of breath carrying my laundry bag such a short distance and after all was said and done, napped for 3 hours to recover!

Beautiful tulips greeted me on my first walk outside.

On Thursday I had a telemedicine appointment with my primary care physician who wanted to check in on me, having been 1 week post-discharge from the hospital. I told her about my fatigue and my heart rate and saturation with minimal activity. She wasn’t surprised – studies were showing that COVID pneumonia patients were suffering from a 20% decrease in lung function for 6 weeks post-infection! SIX WEEKS! What a cruel, horrible virus. How can such a small thing do so much damage to a healthy, young, fit, 27-year-old?! This was astonishing to me, but it was consistent with how I felt. I told her that I felt guilty still being out of work, aware that I was limited by my tired body but frustrated because at rest I was awake and able. She sympathized with me and showed me a different point of view, where other physicians who were still on the frontlines battling war were healthy and unaffected, unlike me. She reminded me, as had my family many times before, that no one would wish to trade places with me, and that it was important I recover a little more before going back into the fight. I was cleared to return to duty the following Monday and was told I would be returning to the floor I had left behind, this time on the medicine telemetry unit, which had mostly been converted into a MICU – working with, you guessed it, Alex. I was elated to be returning to the wonderful pulmonary-critical care department, to be surrounded by the people who essentially helped save me from this horrible virus.

The medication center.

I decided to use my last days off to continue to sleep, eat well, walk outdoors (with my mask!), and video chat with family. I was finally able to enjoy and appreciate flowers my parents had sent me on Easter Sunday. And I wrapped this experience up again, with Alex. My family treated us to a dinner delivery of tapas and we watched a beautiful tribute to healthcare workers on ABC. I spent my last day, Sunday, reflecting on this entire unbelievable 3-week experience. I’m very aware of how lucky I was to have had such a wonderful support system of family and friends. I was lucky to be evaluated in the ER so quickly and to have received the COVID cocktail. I was lucky to have been treated by an amazing attending that truly felt like an older sibling of sorts, similar in age and personality to my sister. I was lucky to have such wonderful nurses who cared for me tirelessly, who helped assuage my fears when I felt short of breath or was struggling with a coughing fit. I was lucky to have an understanding residency program that gave me the time I needed to recover. I was just plain lucky in every aspect possible.

And these are all the memories that I will be carrying with me as I re-enter the hospital, ready for action.

The best family ever.


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