This emergency room doctor from Kirkland survived Covid-19 — just barely

Dr. Ryan Padgett is an emergency physician at EvergreenHealth in Kirkland, Washington. He was hospitalized for more than 16 days after being diagnosed with Covid-19 in early March.

He was interviewed by NPR national desk correspondent Martin Kaste. This interview has been lightly edited for clarity.

I still remember the exact moment when we had a huddle amongst physicians when there was a confirmation of a positive Covid test of our first patient that had passed. And we knew everything had changed.

By Monday the 9th … As soon as I had the fever, I knew what it was. There was not much else out there right now that can get you sick, and I’d only missed five days of work in 21 years of clinical medicine. So I figured that there had to be something unique hitting me. I figured my immune system had seen about everything, and that's the scary thing about this novel virus, right, is that our bodies have seen thousands of illnesses over the years and we've built an immune system that recognizes these.

And the scary thing is when our body see something so fundamentally different that there's just there's nothing in our immune system’s memory bank to help it.

It started to become a big deal when you realize you can't breathe. That's different. Fever and a cough, no big deal.

When you start to realize you walk about 10 steps and you're getting winded or you can't lay flat because you're getting really short of breath. That's when you get a little scared.

As we were taking care of our initial set of patients, our thought was that, you know, the younger patients who had exposure, as long as their oxygen level was okay, that they could be quarantined at home. As we didn't have a specific treatment, it was primarily a home observation situation. And I put myself into that into that category.

I went to the hospital the first time on Wednesday, March 11.

At the time, our turnaround on our Covid-19 testing was three to seven days. So obviously suspicion was high, but we didn't have confirmation.

My oxygen level was doing okay and so went home that day. I’m fortunate I had a colleague that went around me and contacted my fiancée and said, "Ryan isn't looking too great, why don’t you get a home oxygen monitor to keep an eye on him."

Denial is very strong when physicians became patients. So she monitored me through the day and oxygen levels were getting to the 80 percent range. And finally she convinced me to go in. And within eight hours of going back to the ER, I was on a ventilator [at EvergreenHealth].

Swedish [Medical Center] had capabilities Evergreen doesn't have. So when I was put on that unique treatment called ECMO [extracorporeal membrane oxygenation, which oxygenates the blood], that machine is part of a hospital that has cardiothoracic surgery capability.

That is a huge institutional commitment, only about one in four hospitals may have that sort of a program. So a capability beyond my home hospital. [Two hospitals in Washington State have ECMO: Swedish and University of Washington Medical Center].

Once you're on a ventilator, the medicines used for your body to tolerate being on a ventilator has really wiped out the majority of my memory.

I was able to give [my fiancée] a quick call as I was going to the ICU. I have no personal recollection, but evidently I told her where some important documents were just in case. And the next memory I had was about 16 days later waking up at Swedish Hospital.

ECMO saved my life. I dwindled to the point of, my lungs, liver, kidneys and heart all going into multi -system organ failure. That was my only chance. Evergreen had maximized what they could maximize.

I am so thankful they recognized that there’s an ‘X factor’ in my illness. It was that I not only had this viral illness, but that my immune system had caught this wildfire. This cytokine storm. And they were able to recognize that that was likely what was going on. And so being able to be transferred to get the ECMO for my organs. And then there was that experimental treatment through Swedish that saved my life [the arthritis drug tocilizumab, or Actemra].

I felt like Rip Van Winkle waking up 17 days later and realizing that the world had shut down. It was incredible to wake up to that. I came to find out that my wedding had been canceled and the whole city's shut down.

In 17 days, not only our understanding of the illness changed but the world changed.

It went from thinking that this disease was, you know, reasonably minor in otherwise healthy folks -- and that our medically fragile population was the one at risk -- to realizing that this is something that can cut down someone at any age, that this is now this very scary situation: That not only medically fragile patients, but young people could be cut at the knees and taken down by this.

[I was supposed to get married on] May 16.

Perspective changes, I’ll tell you. There's no there's no need for formality when you survive something like I survived. You realize that that's all just window dressing. It doesn't matter.

I'm feeling good. Mainly it's a weakness thing. You don't realize the toll it takes on your body when you haven't moved in two weeks. When you're in a medically induced coma and then medically paralyzed for a period of that time, it's incredible the muscle atrophy that happens. So the physical component is the biggest challenge right now, regaining muscle and coordination. Fortunately, as the medication’s worn off, the mental and cognitive pieces are improving daily.

[Damage to my lungs] to be determined. In general, we're going to take a look at the lungs in a couple of months and see how they did. Right now, you know the limitations I have are more stamina just because I haven't been vertical and active in so long.

Lungs should do pretty well. I did have the ARDS, acute respiratory distress syndrome, which can damage the lungs. But coming into it younger and healthier, it definitely helps. I may have some potential long term kidney damage that we're hoping improves in the short term, then mitigate hopefully chance of long-term injury moving forward. But in general, there's hope for a full recovery in a couple of months.

The hope is to be back to work in a couple of months, absolutely. It's a funny thing, as an emergency physician, you walk in to see every patient that presents to your hospital. I actually feel a little bit of guilt being on the sideline, as I know my colleagues are doing this every day. And so I would do it again. And I will. My family and I all have antibodies, so at least we are assumed to be immune to the current strain.

The realization I have now is that not only does this illness affect our traditional, at-risk population, but it can cut down the young people. And what I experienced, this cytokine storm, is sort of this X-factor that we need to recognize. It can stimulate the immune system so uniquely that that becomes far stronger of an influence of illness than even the virus.

My understanding is if you can recognize the cytokine storm early enough and give this medication, that you can even avoid someone being intubated and ventilated, which would be an incredible, incredible step in mitigating this illness.