x

Feeding tubes, hallucinations and numb toes: One Texan’s battle to survive COVID-19

3 weeks 3 days 10 hours ago Monday, July 13 2020 Jul 13, 2020 July 13, 2020 8:25 AM July 13, 2020 in News - Coronavirus Pandemic
Source: https://www.texastribune.org/
By: by Shannon Najmabadi, The Texas Tribune
Frank Arredondo had one of the first confirmed cases of COVID-19 in the Rio Grande Valley and spent 10 days on a ventilator. (Photo credit: Miguel Gutierrez Jr./The Texas Tribune.)

EDINBURG — Sixty-year-old Frank Arredondo returned from his job as a pharmacist on March 26 and collapsed into bed, exhausted.

His condition quickly worsened. His head pounded, the pain radiating up from his ears. He’d spend hours shivering, teeth chattering, and then wake up covered in sweat. Walking 15 feet to an adjoining bathroom felt all but impossible. He began “panting like a dog,” desperate for oxygen.

An avid runner and tennis player, Arredondo had worried about the coronavirus since it first came to the U.S. because of his age and because he has two 15-year-old stepsons who were acting like “young people,” he said — “very cavalier.”

Now, his body wracked with pain, he wasn’t scared. He was in “survival mode.”

More than 240,000 Texans have been infected with the coronavirus since March and more than 3,000 have died, a number that’s almost certainly an undercount.

Arredondo is one of the lucky ones: He lived.

But as he started self-medicating at home, taking Sudafed for the headaches and extra-strength Tylenol for the body aches, he had no idea what the next few months had in store for him.

He didn’t know that, in early April, he would be wheeled on a stretcher into a South Texas hospital ward for coronavirus patients, with a critically low oxygen saturation level of 78%.

He didn’t know he’d spend 10 days on a ventilator, then several more beset by nightmarish hallucinations.

And he didn’t know that his wife Tyra Greene, a nurse who works at Doctors Hospital at Renaissance Health System, would call the ward multiple times each day to check on him while keeping a detailed log of his treatment.

At the time, Arredondo was one of the only patients treated at the ward, which DHR Health opened in Edinburg, anticipating an influx of COVID-19 patients in the spring. But with Rio Grande Valley officials cracking down on its spread — ordering residents to stay home and setting up checkpoints to ensure compliance — the expected surge didn’t happen.

It came months later, after Gov. Greg Abbott overrode local restrictions and allowed businesses to start reopening in May. That same ward where Arredondo was treated is now packed with people — and DHR Health has spent millions opening a second unit for coronavirus patients and adding more and more beds.

The hospital is currently treating more than 170 coronavirus patients, over a quarter of them intubated, said Dr. Carlos Garcia-Cantu, chief of staff at DHR Health.

"It has been very challenging as our hospital is at capacity as are other health systems in our region and it is becoming difficult," he said, adding that doctors, nurses, and other medical staff are working "around the clock to respond and help to save lives."

Day 12: The emergency room

Greene remembers the day Arredondo went to the hospital. It was April 6 — Day 12 of his illness, according to her personal log of his treatment. He woke up looking pale, unable to catch his breath, and telling his wife he needed to go to the ER. He had learned he was positive for the coronavirus the day before.

Greene had already spent nearly two weeks caring for Arredondo at home, wearing a mask, checking on his vitals, helping him to the restroom, and looking in on him periodically every night. She’d helplessly watched him deteriorate.

When he asked to go to the emergency room, Greene later wrote that she “knew what this meant… 1. He must be feeling really bad. 2. this could be the last time we might see each other."

The couple had met 16 years earlier at the McAllen pharmacy where Arredondo worked. Greene had stopped in to pick up medication. She immediately stuck out to him — he thought she looked like a celebrity. Years later, they bumped into each other again and discovered they both were divorcing. Dating turned to marriage, and they now live in the Valley with three of Greene’s children. Her Facebook page is peppered with photos of the pair kissing and running — and more recently, lengthy posts about her husband’s fight against the coronavirus.

The ambulance drop-off at DHR Health in Edinburg.
The ambulance drop-off at DHR Health in Edinburg. Miguel Gutierrez Jr./The Texas Tribune

Now she was dropping him off outside the hospital and watching him disappear through the double doors. There were no goodbyes, no hugs, she said. Hospital workers told her to go home and quarantine, and that someone would be in touch.

“I drove home and sat there and cried. That’s all I could do,” her notes said.

The first few days Arredondo was in the hospital were a blur of phone calls and worry. He was intubated after one day, and his “anti-inflammatory markers were through the roof,” Greene’s notes say. She was praying a lot. She knew they were entering uncertain territory.

His sedation medication wasn’t working as effectively as the medical staff had hoped and, when they switched it to avoid causing an addiction, Arredondo woke up and started pulling at the tubes connecting him to the ventilator.

Daily chest X-rays showed no signs of improvement. Sedated, he was losing weight and placed on a feeding tube. He was given medications to counteract other medications.

Around Day 17, his sixth day in the hospital, Greene wrote that medical staff told her there was thick phlegm in Arredondo’s lungs that clogged his breathing tubes when he tried to inhale. They suctioned the phlegm out.

His condition slowly began improving.

On Day 22, Arredondo was taken off the ventilator. His vitals were stable, his feeding tube removed. He started drinking clear liquids. That’s about when the hallucinations began.

Greene heard about them when she called him that day.

“Hello baby,” he said, according to Greene’s notes. She told him how much she missed hearing his voice and knowing he was okay.

“The next sentence and the following conversation we had made no sense,” she wrote. “He thought he had been flown to another country when they placed him in the back of an ambulance for transport. He thought he had done some very malicious things and several men were after him from another country. He felt the nurses and doctors were trying to hurt him when they were attending to his IVs.”

Arredondo began pleading with her to pick him up.

“I cut the conversation short because he was getting upset,” she wrote. “I felt so bad for him.”

Day 22: Hallucinations

Arredondo’s own memory of those days in the hospital is blank in places. He remembers being transported by ambulance to DHR Health’s offsite coronavirus ward, quickly hooked up to oxygen and — when there was no improvement — to a ventilator.

The last thing he remembers, before his memory fades to nothing, was seeing people in hazmat-type suits surround his bed.

“Honey,” someone said, “we’re going to put you to sleep.”

He came to a few days later. He heard the sound of the ventilator and looked down at his hands. He tried to move his pinky fingers. He couldn’t. He’d been given a paralytic to prevent him from trying to rip out the ventilator tubes again; the first time, he’d triggered an alarm.

“He’s awake,” he heard someone say. He blacked out again.

But Arredondo remembers the hallucinations that were so vivid that he can still describe what it felt like to have a bullet graze the top of his head when he thought he was shot at. His imagination conjured up a Nigerian hit squad. Texas Rangers. A Mexican cartel. A black ops team. He was convinced he was in a flying hospital and that the nurses had kidnapped him.

It was like a “bizarre cartoon,” he said, but terrifyingly real.

A doctor told Greene that her husband was agitated and mumbling incoherently, and that they’d started seeing similar behavior in other patients who had been intubated.

The phenomenon, ICU delirium, affects about 50% of ICU patients, and around 80% of those with the coronavirus, said Dr. E. Wesley Ely, co-director of the Critical Illness, Brain Dysfunction and Survivorship Center at Vanderbilt University and the Nashville Veteran’s Administration Hospital.

There are several reasons why: The virus causes oxygen depletion and blood clotting that can inhibit the flow of blood to the brain. Coronavirus patients are also immobilized, isolated from friends and family, and often on sedatives that can contribute to delirium.

Arredondo was on several medications including Lovenox to prevent blood clots and steroids to fight inflammation. He said he also received hydroxychloroquine — an antimalarial drug that has been touted by President Trump as a potential COVID-19 treatment. The Food and Drug Administration has warned it can cause dangerous heart rhythm abnormalities.

Day 25: Do you know where you are?

Good news came on Day 25, April 19.

The doctor asked Arredondo if he knew where he was. He did.

Greene called and asked if he knew who she was. “My wife Tyra,” he said.

Relief flooded through her as Arredondo recounted what he’d had for breakfast, and told her he was off oxygen and that the IVs had been removed. Medical staff helped him to the shower, the first time his feet had touched the floor in two weeks.

On the phone with Greene, he told her he loved her again and again, her notes say.

“I said, ‘Welcome back babe!’ … We spoke for an hour. As the nurses came in and out checking on him he would tell me, ‘Hold on, don’t hang up, I want to keep talking to you.’ Oh my goodness I can’t tell you how elated I was,” her notes say.

After her husband recovered from COVID-19, Tyra Greene recently tested positive for antibodies to the virus.
After her husband recovered from COVID-19, Tyra Greene recently tested positive for antibodies to the virus. Miguel Gutierrez Jr./The Texas Tribune

The next day, Greene drove to the ward to pick up Arredondo. She’d been instructed to get a walker and a shower chair, and that he might need physical therapy and help getting to doctor's appointments. He was still taking several medications. She’d hurried to disinfect the bedroom a third time and stock up on his favorite foods.

The door swung open. Greene saw him sitting in a wheelchair, wearing a mask, squinting in the sun, 18 pounds missing from his 5’9” frame. She saw his eyes light up.

“We squeezed each other’s hands as we drove home and nothing else mattered,” Greene’s notes said.

Valley hospitals fill with COVID patients

As Arredondo has been recovering at home, the Valley has been hammered by the virus.

Local hospitals have run out of bed space and run short on staff. The state this month sent hundreds of medical workers to South Texas to help care for patients, and Abbott has paused elective procedures throughout the Valley to free up beds.

Hidalgo County went from having a dozen or so COVID-19 patients in its hospitals before businesses across the state began reopening to now having more than 700, said Dr. Ivan Melendez, the county's local health authority.

During the first three months of the pandemic, the county saw a dozen people with the coronavirus die. That number has soared to 123, Melendez said.

“The other day, I saw a code” — a life-saving medical intervention — “being done in an ambulance parked outside of the hospital because there were no stretchers inside,” he said. “What we’re seeing now when you go to our wards are these open warehouse areas with a bunch of people on ventilators — like if you’re in a war zone.”

All the hospitals in the area were full and diverting patients this week, he said.

South Texas Health System said it was converting conference rooms to add ICU space for critically ill people. Members of Congress asked the federal government to set up a field hospital because the "health systems have been pushed to their limits." And DHR Health, where Arredondo was treated, has converted a rehabilitation center into a second coronavirus ward and has added expensive ICU beds at a ferocious pace. It’s spent more than $9 million on the effort.

Hospitals are also in desperate need of plasma donors, said Sohail Rao, head of the DHR Health Institute for Research & Development.

DHR Health has led a convalescent plasma program since late March, paying people who have recovered from the coronavirus to donate at a blood bank. Plasma containing antibodies is taken from their blood and then sent to hospitals across the Rio Grande Valley, and have so far been given to more than 400 COVID-19 patients, providing them with passive immunity to help fight the virus.

“Unfortunately the donation has been less than what we had anticipated,” Rao said. “There has been a massive need for plasma across the entire Valley and across the entire United States.”

Two months later: back home

Back at Arredondo’s home, Greene has been documenting his recovery. He’s had coffee outside. Taken in the sun and the fresh air. She spontaneously ordered a “welcome home” tiramisu cake.

Arredondo’s feet and toes have remained numb, a symptom other coronavirus patients have experienced perhaps caused by micro clots in the blood. He’s on blood thinners to lessen the discomfort.

Frank Arredondo and Tyra Greene in Edinburg. Arredondo was one of the first patients to be treated for COVID-19 at DHR Health in Edinburg.
Frank Arredondo and Tyra Greene in Edinburg. Arredondo was one of the first patients to be treated for COVID-19 at DHR Health in Edinburg. Miguel Gutierrez Jr./The Texas Tribune

Otherwise, his recovery has been remarkable. He hasn’t had lingering psychological issues — delirium can leave some patients with depression or post traumatic stress disorder. He never went to physical therapy, instead pacing around the house, then making small loops in the backyard. He quickly stopped needing the walker.

He keeps telling Greene how thankful he is for her, and for the nurses and doctors who were unwilling to give up on him.

Arredondo has already given blood to the hospital for research and made a video thanking them for the care he received.

This week, he’s calling them again. He wants to donate his plasma.

The Texas Tribune is a nonpartisan, nonprofit media organization that informs Texans — and engages with them – about public policy, politics, government and statewide issues.

More News

Radar
7 Days