Copyright © 2021 Albuquerque Journal
Editor’s note: Stricken with COVID-19 more than a year ago, long before a vaccine was available, Albuquerque cardiologist Dr. Charles Kim spent weeks on a ventilator in the ICU. As health professionals urge vaccine holdouts to get the shot, Kim and two critical care doctors who treated him agreed to talk about the experience – and why people should get vaccinated.
Dr. Charles Kim knew he was in trouble.
What had begun as mild shortness of breath was getting worse and he was headed back to Lovelace Medical Center, where he had been seen in the emergency room earlier in the day. This time, he would be admitted.
“I remember the day I had to go the hospital,” Kim recalls. “My wife took me, and my (teenage) son stayed home. I distinctly remember telling him this might be the last time we would talk.”
Kim had begun to experience symptoms the day before, July 3, 2020, when most people were off for the holiday, and had gone to get swabbed for a COVID-19 test.
“The next day (July 4) I woke up and said I’m really short of breath. I said, ‘Something is not right,’ so I came back to the hospital. I had already had the swab with results pending.
“They found my oxygen was a little bit on the low side, but I didn’t feel terrible. The ER doc said he could admit me or send me home and ‘see how you do.’ I said I’d rather go home. Oxygen was delivered, and I was put on 2 liters, a low standard amount, around noon. Six hours later, I was incredibly short of breath and I was dialing up the oxygen, needing more and more just to maintain saturation above 90.
“At that point, I knew I was in trouble and thought, ‘This is bad.'” He went back to the hospital and was admitted.
“Two days later, I just couldn’t breathe at all. I remember that sensation and going into the ICU. The person on duty was Sophia Rogers, a nurse practitioner I had known since 1998. I distinctly remember telling Sophia. ‘I cannot breathe. You have to put me on the ventilator.'”
Before that happened, he called his wife and texted some close friends to tell them, “I’m pretty sick and that I was going on the vent.”
• • •
More than 4,400 New Mexicans have died of COVID.
Kim, 56 and an interventional cardiologist with the New Mexico Heart Institute/Lovelace Medical Group, knows he is one of the fortunate ones who beat the mortality odds for COVID-19 patients who go on a ventilator. He spent about five weeks on one and nearly died on more than one occasion as doctors and nurses in the Lovelace Medical Center ICU worked round the clock to keep him alive.
He was one of four health care workers at the Heart Institute who tested positive for COVID in late June and early July of 2020, according to news reports at the time. The Department of Health said the institute had followed all procedures.
For a patient about to be intubated, Kim’s conversation with family and friends is one the physicians who cared for Kim have witnessed too many times – and one that is especially gut-wrenching now because it occurs almost exclusively among patients who have chosen not to get the vaccine that wasn’t available to Kim in the first part of 2020.
“I’ve stood at the bedside and watched more people than I can count – young people and old – talk to their families when I knew there was a good chance this might be the last time they talked,” said Dr. Jeffrey Mazer, a pulmonologist and critical care specialist. “I can go around to each bed in the ICU and remember a conversation at every single one where somebody talked to their 13-year-old son or 7-year-old daughter or 25-year-old wife to say goodbye.”
And the patients usually know what’s happening to them.
“The progressive shortness of breath with COVID is different than other pneumonias that are systemic. Most COVID patients have been lucid right up to the point we’ve put them on the breathing machine,” Mazer said.
“Then they either lose five or six weeks of their lives like Charles did – or more – or they don’t wake up at all.”
• • •
Kim was in critical condition during most of his six weeks in Lovelace Medical Center as caregivers in the ICU treated him with Remdesivir, the FDA-approved anti-viral drug, steroids and antibiotics along with various kinds of sedation and ventilator “maneuvers.”
Kim is well aware now of his brush with death.
“Dr. Mazer and his associates took phenomenal care of me,” he said. “Only later did I learn that I almost died twice – maybe more but at least two distinct episodes. Each time they were able to pull me through.”
“Charles was a bit of a petri dish,” Mazer said. “He had a super infection in his lungs and developed what is known as a C. diff infection after being on antibiotics for his pneumonia. We treat the acute events that come up and work to manage the COVID itself.”
Mazer said people hit hard by COVID-19 often develop acute respiratory distress syndrome, or ARDS. “They progress to profound hypoxia. No matter how much oxygen we deliver, we can’t get enough into them.”
• • •
Kim says he doesn’t remember much after going on the ventilator. The doctors and nurses in the ICU, however, recall their efforts to keep him alive – and their fears he wouldn’t survive.
“I think there were times when we did think Charles was going to die – that he wasn’t going to make it,” Mazer said.
“From the moment he was intubated, it was a crisis for all of us,” Mazer said. “Taking care of someone you know is hard and it’s even harder if it’s someone the system knows – by that I mean all of the nurses and all of the doctors, the community that we live in.”
“After Charles went on the vent, Sophia (the nurse practitioner) called me in tears … ‘I’ve known Charles for 20 years and he almost died on me tonight,'” she told Mazer. “I don’t know what I would have done.”
That level of crisis, Mazer said, “is something we all felt,” recalling daily phone calls to Kim’s wife and what she was going through during a time when families weren’t allowed inside hospitals because of COVID.
“It was a terrible time for patients and families,” Mazer said. “Keeping families away from their loved ones was and is a terrible experience for patients and families.”
• • •
Dr. Theresa Heynekamp, also a pulmonologist and critical care specialist, describes treating Kim and other COVID patients in the ICU and on ventilators this way: “We feel we are watching people suffer for weeks on end, and Charles was having a lot of difficulty with fevers. One of the most profound things is that we are wearing our full gear and people are on varying levels of sedation so they are very confused.
“The amount of fear I see in people’s eyes – and in his eyes – I remember telling him that, ‘I’ve never met you but we’re going to get you through this.’
“But inside I felt like I was lying. I was trying to encourage him but I wasn’t sure he was going to make it.”
• • •
Kim, thoughtful and soft-spoken, recalls the day in mid-August 2020 when “I remember opening my eyes and realizing I’m not on a vent. I was told that it took about three days for me to wake up.”
Dr. Mazer chimes in, telling Kim that “you and I had several days of conversations you don’t recall anything about.”
As Kim processed what had happened last year, he began to wonder whether he had any “neuro deficits.”
So at some point, he said, “I sat down with a piece of paper and derived the quadratic equation. I could still do that. So I thought, ‘OK, my high school memories seem to be intact because I can still do algebra.’ ”
• • •
Shortly after he came off the ventilator, Kim was discharged from Lovelace Medical Center to Kindred Hospital, which provides acute long-term care. He spent the next three weeks there.
“I was on oxygen and too weak to care for myself,” he said. “I couldn’t sit up in bed or feed myself. I could do that by the end of three weeks but could barely stand.”
He was discharged from Kindred on Sept. 1 and admitted to Lovelace UNM Rehabilitation Hospital, “where I spent the next three weeks learning to walk. I had been bed bound for two months and lost 40 pounds. My muscles atrophied. I started by walking 10 feet, then 20, then 40. The day before I was able to go home, my physical therapist and I walked around the block – with a walker and an oxygen tank.”
He left the rehab facility on Oct. 1, 2020 – nearly three months after his wife drove him to the Lovelace Medical Center with shortness of breath. Staff, friends and colleagues with signs and balloons gathered to cheer him on as he slowly walked out using a cane. Cries of “I love you Charles” rang out and can be heard on video taken that day.
• • •
More than a year after he was stricken with COVID-19 and nearly 11 months after leaving the rehab facility, Kim has yet to regain all his strength.
“In January, I was getting restless but wasn’t sure I would be strong enough to go back to work. So I went over to New Heart and did a month of rehab with them – walking on treadmills and riding bicycle – just to see if my physical stamina would improve. I came back to work in the office part time in early February and am still doing physical therapy, hoping I can get better and stronger to return to full-time work.”
The last time Kim had been at work was the first week of July 2020, before he felt any symptoms. He and his staff at the institute were doing temperature checks and wearing masks.
The institute is still requiring masks and taking temperatures. Kim said he isn’t doing procedures but is caring for patients in the office. He described himself as a “.6” employee.
How is he feeling?
“My energy is still not 100%. I still get fatigued but can carry out most daily activities.”
“My oxygen level during the day is fine (he was able to discontinue supplemental daytime oxygen in December), but I still use oxygen at night.”
• • •
To Kim, Mazer and Heynekamp, there is little reason to debate getting a vaccine that in almost all cases has shown it can prevent a COVID-19 illness like the one that was nearly fatal for Kim.
“New Mexico has been very good with people getting vaccinated but we still have a long way to go,” Kim said.
“The science behind the vaccine is very good, and we know the consequences of not being vaccinated. Ninety-eight percent of our inpatients did not get vaccinated. We know that people with vaccines can still catch COVID, but usually much milder, and they are not the people who end up in the hospital.”
“I would recommend everyone eligible should get it. I’m not a virology or public health expert, but if we could instantaneously have the whole country vaccinated I think we would see COVID drop dramatically.”
Even though he had a severe case of COVID-19, which creates antibodies, Kim was vaccinated in January before returning to work.
“The experts said get it, so I did.”
He took the Pfizer shots. He said he felt fine after the first and was under the weather for a couple days after the second.
Mazer was one of the first Lovelace employees to be vaccinated when the shots became available.
“It’s a strange place to find us with excess vaccines sitting in Walgreens and Walmart and no one interested in getting it,” he said.
• • •
Heynekamp, who has a background in microbiology, said the RNA technology in the Pfizer and Moderna vacines isn’t new. It’s the pandemic, funding and commitment that pushed it to production in record time.
“It’s been around for years, even if people perceive it as urgent.”
The vaccine remains on emergency use authorization and full FDA approval will help, she said. The fact there are health care professionals who have chosen not to get vaccinated “is very concerning.”
“I think all of us have some PTSD from last year, and looking ahead and thinking it (a surge) could happen again is frightening. And if it does happen again, I think there is going to be an epidemic of severe stress in health care providers.”
Heynekamp said of watching people suffer with COVID, standing at the bedside and listening to them say goodbye to families, “It’s a lot of moral injury.”
“I don’t know how to educate people more and tell them about the suffering we’ve seen – not just in patients, but families and health care workers.”
“Even last week, I was taking care of a 30-year-old who didn’t actually believe in COVID up to the point they were intubated,” she said. “We feel like sometimes we are beating our heads against the wall.”
“A lot of people are choosing not to be vaccinated for something that feels completely preventable,” she said. “We don’t need to do this.”