An email from a physician treating COVID-19 patients near the Tyson processing plant.
It is Real
We treated our first patient last night.
Patient #1 is a middle-aged Hispanic male from the Tyson packing plant. He has no co-morbidities. Fever and test (positive) a week ago. Admitted 24 hours prior on 6L [liters of oxygen, CF] and quickly progressed to 8L, still hovering low 90% on pulse ox (oximetry – oxygen saturation, CF).
The typical — go to see him and he is eating dinner, go back and he was so short of breath from eating. It was hard for him to talk. Thankfully while sitting in the unit, his daughter called. She is in medical technology school and wanted him to try HBOT. The new shift for overnight staff came on. The nurse practitioner who had admitted him the night before is bilingual, so we could fully explain and consent. He said “yes.”
By 9:15pm we had him in the HBO unit and ready to start. When he started the treatment he was visibly uncomfortable, and short of breath. We pretty quickly took him to 2 ATA (Atmospheres Absolute – two times sea level pressure which is the equivalent of being 33 feet under the ocean, CF). At 2.0 ATA he was visibly more comfortable and said he was much better. His daughter was on FaceTime the whole time. (I need to figure out a better way for a patient to listen and hear from a cell phone through the chamber intercom). We did a lot of “thumbs up if you are better, thumbs down if you are not” and want to stop the treatment, “wavy hand if you are okay to keep going” in the treatment but not better. Anyone with better ideas, please advise. I have been told to not expect that any of the patients I will be treating will speak English. Translators are available but that’s a phone call and same issue with the intercom.
I increased the chamber pressure to 2.2 ATA once I felt he was stable, and treated him for an hour.
The TV/speaker volume on the chamber was too loud for him. But turning that down turned the phone volume down and he couldn’t hear his daughter when she was speaking through a cell phone on the outside. Moving the phone to mouth piece when she spoke and ear piece for her to hear him, things improved. Turn it up and it was too loud, turn it down and he couldn’t hear. We finally found the right spot.
Treated for 60+ minutes of bottom time (bottom time is the total time that the chamber is compressed, CF). He started fidgeting and I didn’t want him to feel trapped, so we started bringing him up sooner than I would have wanted but he was improving and giving a thumbs up. Marathon, not a sprint after all.
He had to have an oxygen mask on before exiting the chamber. When we pulled him out, he was visibly uncomfortable — through a translator he said he was nauseated. Why? His sense of smell had returned after HBOT and the mask odor made him sick to his stomach!! Alcohol swab did wonders and he was able to put his mask back on for transport back to the ward. He acknowledged he was feeling better, but his daughter left FaceTime as his wife was ill and she was going to bring her to the ER.
I didn’t send this email until I could see him this morning. He was lying with the bed flat. That’s a good sign since you can’t lie flat when you are unable to breathe. His oxygen saturation was 98%. He was still on 8 liters of oxygen, which is what he had been on the day before. (Reminds me that another detail to address is weaning down the supplemental oxygen after HBOT. However, when a ward has 7 COVID-19 admissions overnight, I suspect I will be doing the weaning of the oxygen). Best of all, he was sound asleep and visibly breathing much easier.
We are off to an incredible start. More calls this morning, meeting more physicians, staff etc; There are more patients than we will have time to treat. If you know me, I couldn’t be happier!!