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A NEAR CASUALTY OF COVID COLLATERAL DAMAGE: A PATIENT’S STORY

On May 7, 2020,  I first heard about 20-year-old Jose (name changed) when I received the above text message coming from another hospital.
Translating the message above in Spanish from his father, it said: 
 “Right now, the hospital is treating Guillain Barre and Porphyria, he already has been in the hospital 13 days, and they don’t know what it is, they have him intubated, they placed a tracheostomy, he is in the ICU, my wife says maybe this Monday they will be able to downgrade his care, but I think he will have much less care, they want to evacuate patients because the priority is for patients with COVID19, and they are going to stop caring for the others, it is for this reason that we would like to transfer him.”
 
Jose had Guillain Barre Syndrome, which basically occurs when your own body’s immune system, in fighting off another infection, accidentally creates an antibody that ends up being similar enough to your own nervous system that it attacks it.   It paralyzes you.   In severe cases (as was with Jose), it paralyzes your body to the point that you cannot even breathe for yourself.  Unless you are connected to a ventilator, you die.   How long it takes to recover depends. A number of factors, including how bad the damage is to the nerves and how long it takes for them to “grow back”.   Usually, that means weeks to months.
The question being posed was would we accept this transfer from THE largest hospital in Honduras in the Capital city, basically at least an 8-hour drive away?  There was concern that his hospital would determine that Jose would need a ventilator too long, during a time when they needed ventilators for COVID, and that they would disconnect him before his body was ready.  His family was desperate for alternatives and was begging us to bring him to our hospital and put him on one of our ventilators.  They were afraid he would be left to die if he didn’t get out.
    *there were 6 total deaths and ~200 total cases of COVID (asymptomatic, mildly symptomatic, and severe in total) in the entire country of Honduras at the time of this conversation
Admittedly, sometimes families exaggerate or lack understanding or have poor communication with their doctors and so the story we get isn’t always the gospel truth of the matter.  But in this case, their concerns seemed valid based on what we found when they finally arrived.

Normally, a family is responsible for feeding their loved ones who are in the hospital. Much of what we would consider nursing care is often done by a family member who stays night and day with their loved ones.   But because of COVID, no relatives were being allowed in the hospitals.  Given that Jose was completely paralyzed and ventilator dependent, literally unable to lift a finger and unable to talk, he was not being fed and reportedly not being adequately cared for.  When he arrived, he had not been fed for 14 days, anything except IV fluids, no TPN or enteral feeds.  He was wasting away and it didn’t look like he was going to tolerate the starvation much longer.   It seemed like the family’s concerns that he was going to die without a change in scenery were not unwarranted.  The fear of COVID was already hitting Honduras and affecting patients and their care before the virus even had really spread to any significant level.
Fortunately, when Jose arrived at Loma de Luz, he did not need a ventilator anymore and we were able to gradually wean him off supplemental oxygen and tracheal suctioning.  Probably most importantly,  we started feeding him immediately.   It’s a lot harder to heal when you’re malnourished.
Initially, we fed him through a feeding tube until he was able to swallow.  Then after talking through his care with an ENT doctor in the States, we changed him from a cuffed collar (inflates to block airway) to an uncuffed trach collar.
This was done to allow him to start to breathe around the tracheostomy tube, allowing air to pass through his vocal cords and bypass the tracheostomy hole.
Finally, we were able to put a cap on the hole.  When that was done, it forced all air with breathing to go through the vocal cords.  It was at that moment, that I heard Jose speak for the first time.  It was like hearing your own child cry for the first time at birth, after having waited so long to meet them.  He spoke to me in perfect unbroken English, not at all what I expected; it was a great moment of joy.
Gradually, Jose gained strength.  At first, it was moving his head.  Then talking.  Then later moving his shoulders.  Then his fingers.  Finally his legs.   Day by day, week by week.
He had to practice breathing and sleeping with his Tracheostomy tube closed as a test of whether he would be able to tolerate finally removing it.  Praise the Lord, he did well and we were finally able to pull it and to God’s glory, he was able to go home for further rehab and recovery.

It is always such a privilege to work with someone who has been so close to death and survived.  It often feels like maybe meeting someone who has been to heaven and back. Their words are always clothed in grace and humility, and thankfulness.  We were so thankful for God’s grace in Jose’s life to give him life beyond his first 20 years.

I’ve recently been thinking a lot about the meaning of “Twas grace that taught my heart to fear and grace my fear relieved” in that verse of the song Amazing Grace.  How did grace teach John Newton’s heart to fear?
My own thoughts are that God is not required to give grace to anyone, otherwise, it would not be grace. If He’s not required to give grace, then He is not required to save (knowing that salvation is by grace alone).  So to depend upon something for salvation (that is not in our control nor required of God) is a fearful thing.   And yet, as John Newton immediately coins following, “and grace, my fear relieved.”   God is gracious to save, even a wretch like me.   This is part of what makes that grace so precious, He doesn’t have to save, but He does.
Please keep Jose in your prayers as we thank the Lord for saving him, by His precious grace.

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