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On Pandemics & Uncertainty: One Rheumatologist’s Story

Belinda Birnbaum, MD  |  April 24, 2020

I had to convince the department of health that I should qualify for rapid testing by virtue of rounding in the hospital and seeing patients with pneumonia, even though none of them had been tested or recently traveled to China, Korea, Italy or Iran. The surreal experience of drive-through testing was frightening. A nurse in full hazmat suit swabbed my nose through the open car window while another counted to 30.

I drove home. I waited. I couldn’t smell dinner or the next morning’s coffee, and the results came back positive.

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I’ve never loved a nurse more than the one who stuck that IV in my arm. As a patient with a communicable disease with no effective treatment, I say that someone who leans close to me to help earns my eternal gratitude.

What would this mean for everyone around me? Fear and guilt washed over me.

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My office was professionally cleaned. I prayed my mask had been enough to protect others. I texted friends, neighbors and colleagues, all of whom asked, “How did you get it?”

Of course, I still don’t know. It could have come from one of those coughing patients I saw, from one who hadn’t started showing symptoms yet or from one of the febrile patients my husband, an oncologist, saw the same week—or from the supermarket. How should I know?

“It’s COVID, not chlamydia!” I shouted at my phone.

I answered only the most supportive and caring texts and those from people who offered to bring dinner for my family.

I was unclear how to protect my family. As I realized I should separate from my family, my husband got rapid testing through his workplace and was also positive. He had no fever, but he was tired, had a headache and coughed. He moved into our office.

The fear of decompensation was constant. Three days in, I could barely walk from my bed to the bathroom. I would wake up drenched, shivering and still febrile. Trying to take in a full breath hurt. Anorexia and abdominal pain worsened with each fever spike. I tried to lie prone but felt more comfortable on my side. A 24-hour day narrowed to the six-hour intervals between acetaminophen doses. I couldn’t muster enough energy to shower, and I wondered if the loss of smell served an evolutionary purpose.

Given the available evidence, I considered taking hydroxychloroquine, but thought, “That’s my patients’ drug. There’s a shortage for them.” I spoke with my health systems’ chair of medicine and wise infectious disease doctor, Lawrence Livornese, MD. He agreed with my decision to start hydroxychloroquine and asked me to watch my oxygenation. Despite my uncertainty, I swallowed four 200 mg doses over 48 hours, but stopped after vomiting.

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Filed under:ConditionsOpinionSpeak Out Rheum Tagged with:BirnbaumCOVID-19

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