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Recovering from Covid-19 After Hydroxychloroquine Proves Damaging to the Heart

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MASTERS: Miguel Braceli

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Baltimore COVID-19 News Updates from Independent [...]

How are you doing? Are you feeling better? I receive a few texts like this every day. I appreciate the concern, but formulating an honest answer is an exercise in frustration. 

Sometimes I write back with emojis, especially the one with the woman holding up her hands, gesturing an emphatic “I don’t know??!” It has been more than six weeks since I got sick and four since I was released from the hospital for Covid-19 pneumonia. I’m definitely recovering, but I don’t yet feel like myself. I have begun to wonder if I ever will.

It’s been three weeks since my ER doctor called to confirm that I tested positive for Covid-19 on April 3, a full 14 days after qualifying for a test that should have been available the first day I had a fever of 102 (March 16)—not eight days and a serious bout of pneumonia later. I got sick right after schools and businesses were closed, and assumed the lack of testing available was a temporary bottleneck, not the reality of healthcare in the USA during this viral outbreak. Six weeks later, we still lack adequate supplies for testing in this country and our federal government appears to be doing nothing to coordinate this effort, unless bad reality TV is a cure for coronavirus.

The entire planet is gripped with dread and fear due to the spread of the virus, but I should feel “normal” by now—whatever that means in a world where everything is cancelled. Although my pneumonia wheezing is better, for the past few weeks I have been experiencing chest pains.

This is particularly frightening after reading about the life-threatening effects possible from a combination of Hydroxychloroquine (Plaquenil) and Azithromycin, the drugs I was given in the hospital. Every day, there are a slew of articles claiming that the combination of these two drugs can cause permanent heart damage, that the drug was never approved by the FDA for this use, that it has made patients with Covid-19 worse, not better.

How am I? Am I finally back to normal? I want to be, but I am not.

I still tire easily and don’t have much appetite. My senses of taste and smell have returned, but certain foods I never liked before, mostly junk, taste good to me now, while some of the healthy staples I used to consume regularly smell rotten. I can breathe deeply now without any resistance or coughing, so that is a major improvement and I am thankful. The hospital sent me home with an Albuterol inhaler, but this week I haven’t needed to use it, so I count that as a victory. 

L: Andy Warhol, Valentine’s Hearts Ads ( ... Having a Heart Attack), ca. 1982-1983, Synthetic polymer paint and silkscreen ink on canvas, R: Portrait of Cara Ober by J.M. Giordano

However, the chest pains have become a regular part of my day. They are strange, dull pangs under my sternum and I can only sleep on my back because side sleeping intensifies the pressure, like my heart will explode. They don’t hurt enough to impair my movement, and they come and go unpredictably.

I have never felt any sensation in my body like this before and it’s alarming, buffeted by all the sensationalized articles I feel compelled to read. I’m enraged to see the President, desperate for a quick cure and a return to economic stability, along with Fox News, promoting Hydroxychloroquine, a treatment for malaria and lupus, as a miracle cure for Covid-19 despite zero scientific proof. I wonder what he’ll recommend next and don’t have to wait long for news about his idiotic suggestions for bleach and ultraviolet light as treatments to circulate and distract attention from the hydroxychloroquine debacle that was entirely preventable. The news, especially that doctors are being pressured by the federal government to use untested cures for a deadly virus and that top epidemiologists were fired for disagreeing, carries serious health implications for everyone.

I suspect my chest pains may be anxiety, from reading the news and the general dread we are all feeling, especially the proliferating stories about so many sick and dying, the mobile morgues in NY, and the panic of being around other humans. We are terrified of getting sick, spreading sickness, and being responsible for someone else’s death, as well as the larger fears around economic instability, poverty, and starvation. I feel very lucky to have recovered from my fever, chills, and pneumonia, and thankful that my family is healthy, but heart pains are a new sensation and indicate that something is wrong. 

I am normally a healthy person. Until I got sick this March, I was running about three miles a day outside and regularly lifted weights in the makeshift gym in my basement. Before Covid-19, I had never had shortness of breath nor chest pains. Now, no amount of Advil, typically used to reduce inflammation, makes a difference. 

After a few weeks of checking in, my doctor prescribes two tests to rule out heart damage. One is an angiography, an X-ray of the chest using dye injected through an IV in the arm, and the other is an echocardiogram, an ultrasound of the heart. I am able to quickly schedule the first test at a local radiology office and a day later I am in an empty waiting room, checking in with two receptionists wearing masks and gloves. They are scheduling just one patient at a time because of Covid-19, so I quickly find myself changing into a paper vest before a nurse inserts a needle into the vein in my arm, now a familiar feeling.

She explains that the dye will feel intensely hot and some people feel like they’re peeing their pants while it circulates through the veins. I lie down on the bed in the scanner, a round white space ship that I have seen before in movies. I hold still and hear a whirring, holding my breath while the machine takes photos of my chest cavity. I close my eyes and feel the burning warmth coursing through me, and it’s bizarre but not unpleasant. Mostly, I worry about what the test will reveal and my chest hurts more than usual. I close my eyes and get through it. 

L: Andy Warhol Heart Human Heart, 1979, Synthetic polymer paint and silkscreen inks on canvas, R: Cara Ober self portrait at home in bed

An hour later I get good news. My doctor calls and says that the chest X-rays show that I do not have any blood clots, which was his primary concern. I had no idea blood clots were even an issue, although recent articles indicate it is a major cause of death with younger Covid-19 patients, and I am grateful he hadn’t told me before this. He says my lungs still show signs of pneumonia but look better than when I was in the hospital. I feel jubilant and healthy. Finally. I’m halfway there. 

Scheduling the echo proves more difficult. I spend countless hours on the phone listening to elevator music, playing phone tag between doctors and receptionists before being told that cardiologists are only taking “emergency” cases and I don’t qualify, despite my doctor’s STAT order. I get it. We are experiencing a complete breakdown of our healthcare system and every doctor and healthcare worker needs to create protocols that protect them. All non-essential medical procedures have been cancelled. I understand, but I’m still having chest pains. 

For many who got critically sick with this virus, recovery is complicated and unpredictable. We don’t have any data around how long it takes to get back to normal, or whether we are actually immune, or what symptoms may still show up. There is very little health care available for anyone who is sick—this is not safe or effective, but our system has been pushed to the brink of catastrophe.

My doctor finally scores me a cardiology appointment at an office near his, about an hour away from my home. I have to wait two weeks for the appointment, but I am flooded with relief because it means that I will finally have confirmation about the condition of my heart, which may require medical intervention.

I wear a facemask and douse my hands in copious amounts of hand sanitizer in my car before entering the medical building, which is unusually dark and quiet. On Wednesday, April 22 I am the sole patient in the cardiology office. The sonographer is petite and blonde, her face covered by a medical mask. She is the only medical professional here, except for a receptionist who checks me in from behind glass. The empty waiting room has about 30 chairs and every other one has a printout taped to the seat, instructing patients not to sit there to keep social distancing protocols in place. I do not sit down. 

After weeks of waiting and worrying, where my chest pains varied from nonexistent to medium, I am finally in a cardiology office that only conducts tests two days a week, and I am terrified about what this test might reveal but thankful to be seen. I enter the examination room and put on the blue paper vest. The sonographer places stickers around my chest and attaches wires to them. Then she instructs me to lie on my left side, which immediately causes pain intensified by the anxiety I am feeling.

She places the ultrasound wand covered in warm goo against my chest, prodding gently into the exact spots where I am feeling pain. As she navigates my heart’s valves and chambers, taking photos and video of the pumping action in my chest, I imagine what it could be like to live with a damaged heart from now on. Occasionally the sound comes on, a WOW… WOW… WOW, with the staccato percussion of my heartbeat underneath. It sounds so fast. Is my heartbeat elevated because of my fear? Is it throwing off the test? How can you tell if your heart is healthy? 

I have never ever felt anything except for a vague sense of camaraderie towards my heart when exercising, a general sense that it’s fun working together. Now I have to wonder: What if my future is suddenly cut short or I spend the rest of my life dealing with the impacts of an illness that are only now becoming known? After the exam, I wipe off the goo and the ultrasound tech tells me my test will be analyzed by the cardiologist the next day, and then my doctor will call me with the results in a day or two. I have no idea what to expect and the sensation of pressure in my heart is more potent than ever, but I also feel relieved.

We have so much free time right now and the news is a constant barrage of changing information and absurdity. I try to focus on work, but my mind travels in a million different directions and the world feels so different now. All the illusions about available and competent medical care and the efficacy of the USA navigating this crisis based on the professional expertise of epidemiologists, doctors, and economists are gone. There is no organized system for battling this virus, medically or economically, and realizing that, more than ever, we are all on our own and it’s luck more than anything else that can protect us, is demoralizing.

What we are dealing with is unprecedented in every way. We are suffering from a complete lack of normalcy and all that is left is insecurity. We are so much more vulnerable now than before, and those who get sick with Covid-19 are at the mercy of a federal administration that has willfully ignored the advice of epidemiologists since January—because it’s an election year and the president wants the economy to go back to normal, but without actually doing anything to make it happen. This laziness and lack of trust for the professionals prepared to rebuild our country, based on science and proven research, is staggering.

No one makes their best decisions under duress, and our healthcare system has been utterly depleted by the Covid-19 pandemic. Although the USA is home to thousands of epidemiologists and some of the world’s most esteemed doctors, apparently few of them work for the federal government anymore and none of them were included on the president’s coronavirus task force. As a nation, our healthcare system has been hobbled and stymied by an administration that aimed first to cover up the virus in order to stabilize the stock market and is now using this health crisis as a pulpit for misinformation and cringe-worthy self promotion.

Despite claims to the contrary, the US is still failing to provide even the minimum level of testing needed to get our economy on track. As a country we are unable to take care of those who need it most, especially the elderly and communities of color, making already vulnerable populations that much more so and creating economic instability for everyone. As the wealthiest country in the nation, we should be able to proudly come together with generosity and science-based strategies to combat this virus and to equitably distribute economic resources to everyone who needs it because we are all connected, our survival is collective. This is in the best common interest of everyone, rich and poor, but it’s been several months and the only discernible federal outcome that can be counted on is bad reality television. 

L: Andy Warhol, Heart Shaped Candy Box (True Love), 1984, signed, inscribed, dedicated and dated 'TO LIZA H.B. March 12 Andy Warhol 84' (on the overlap), Synthetic polymer and silkscreen ink on canvas, R: Portrait of Cara Ober by J.M. Giordano

People like me who contract the virus and receive medical care are forced to accept whatever medical options are available, including experimental and unproven methods, like hydroxychloroquine. My heart has felt sore and bloated in my chest for weeks. This is a medical issue that requires a medical solution, increasingly rare during a medical crisis. There is so much we don’t know about how this virus works, with the news shifting daily with radically different conclusions from hastily conducted studies and misinformation. If a baby alien suddenly pops out of my head or I wake up a Corona-zombie, I honestly would not be that surprised.

Like most of the negative impacts of Covid-19, my current health situation could have been avoided. I did not need to get this sick. I do not need to spend the rest of my life treating a chronic heart condition, the same way our country could have avoided an economic collapse if we had not watered down Obamacare to please insurance companies or defunded the life-saving federal agencies that could have prevented much of the emergency we are living in or, for that matter, elected a reality television star who has never had an actual job before. There are so many things to feel angry about, it’s hard to channel your energy into something useful and good. 

Two days after my echo, my doctor calls. His voice sounds upbeat and I feel my body relax in a way that it hasn’t in weeks. My heart is okay, he says, but the lining of my lungs is irritated. He prescribes steroids for the inflammation and predicts the pain should dissipate in a few days. I feel a huge swell of gratitude, to have a doctor that cares and takes me seriously, and for the news that I will be able to continue to live my life in my body in a way that makes sense to me. I am grateful, but I am also consumed with anger at the needless waste of life and resources, the stupidity and hubris that has damaged our collective future beyond measure. 

How am I doing? Am I feeling back to normal? I guess so? The new normal, that is.

As a nation, we are only as strong as those making decisions at the top. Doctors take a Hippocratic oath to treat their patients as best as they can, but without proper research, medicine, and testing, they are forced to make the “least bad” decision for patients who are sick and dying, an untenable and tragic predicament that could have been avoided.

As a country, we have proven ourselves inadequate in taking care of all those who need medical intervention in a crisis. I worry about how long this is going to last, not just the risk to life and health but also to our economy, our cultural sector, to life as we have known it.

All we have right now are our decisions and the impact of these choices. I wish I had said no to the clinical trial of hydroxychloroquine in the hospital, but I was scared and sick and desperate, so I own this bad decision, which was aided by well-intentioned but overwhelmed doctors.

We all need to make better decisions. We need to hold our leaders accountable to professional standards. We need to make sure hospitals are properly funded and those who work at them are supported and protected. We need to offer health care for every single American that is not tied to one’s job, because jobs disappear during a health crisis and this further destabilizes our collective way of life. 

Our choices have consequences. We used to have a functioning federal government that valued expertise and professionalism and we need one again, so that we make better choices in the future. This is the only way that we will be able to individually and collectively heal.

 

 

L: The author with her son and dog at home, R: Andy Warhol, Heart (I Love You), 1984

Header Image: L: Andy Warhol Heart, ca. 1982, Silkcreen/collage, R: Self Portrait in the Hospital by Cara Ober

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