Surviving COVID-19 With An Underlying Health Condition

Coronavirus: This is how it feels to be in intensive care with COVID-19 - a survivor's graphic story
"I had never felt so alone in all my life," writes coronavirus survivor Robin Bowler in his incredible, hopeful story of recovery.
By Robin Bowler  https://news.sky.com/story/coronavirus-this-is-how-it-feels-to-be-in-intensive-care-with-covid-19-a-survivors-graphic-story-11973549

Robin Bowler, a lottery and gaming consultant, feared he'd never see his kids again after contracting coronavirus and ending up in intensive care - but a voice in his head somehow got him through.

This is a story of hope, his story - a survivor's story:

If you were to write down the classic set of conditions that a single person may have, in which COVID-19 could thrive, you would probably end up with a profile that looked remarkably like me.

I am 58, I have asthma, I have one of those much-mentioned "underlying health conditions" - namely chronic lymphocytic leukaemia (CLL) - I am blood group A (reportedly more susceptible to the more aggressive form of coronavirus, with a high proportional death rate), and until recently, drank more than I should.

On the plus side, I happen to have a good level of underlying fitness and spend a lot of time outdoors.

So that's me. Well, almost.

I returned from Italy on 7 March and first began to feel some slight chestiness during the evening of Monday 9th. Following a call with 111 I was recommended for a COVID-19 test, which was done on the 13th and I received confirmation from Public Health England by telephone the following Tuesday 17 March.

In the meantime my previously mild condition had turned for the worse into flu-like symptoms, and I could feel an infection growing in my chest.

By the Thursday night I was having serious problems breathing. So at 5am on Friday 20 March I called 111 again and was hospitalised that morning in an isolation room in the Lulworth ward of Dorset County Hospital.

Incredibly, at this time I did not feel particularly frightened, although the enormity of my decision to go to Italy was dawning on me - as was the realisation that if this got really serious, I was on my own.

There would be no family to visit, no contact with NHS staff other than that which was essential, an intercom to speak to front-line staff safely. Just me and the four walls of my room and its contents.

By Sunday 22 March it was clear that the committed care I was receiving from the doctors and nursing staff on Lulworth ward was simply not working.

A second chest X-ray revealed that what had been originally described to me as a "pneumonia" had worsened, my temperature spikes were climbing dangerously close to the 40C mark on multiple occasions, and I was weakening by the hour.

At this time, what was really bothering me was the fact that there had been a suggestion that they would send me home within a day, and I knew that I would not cope without the specialist care available within the hospital.

My concern levels rose to full anxiety and therefore late that afternoon I asked to speak with a doctor and, during a dialogue in which I became very emotional, he calmly reassured me that there was no way I would be sent home against my wishes, and that they would not consider discharge unless they were sure I was safe.

Shortly afterwards, I was visited by a senior consultant who I believe introduced himself as head of critical care at DCH.

He informed me that, having reviewed my situation, the decision had been taken to move me to intensive care as a precautionary measure, warning me in no uncertain terms that this was going to be a long haul.

He then fixed me with a hard look and added: "You may not survive this."

I responded (equally calmly, I think): "I'll do what I have to do."

But inside, I could feel my confidence crumbling, my fear rising to hitherto unknown levels, and my mind starting to run amok with self-recrimination, longing to be with my (adult) children Natasha (Tash) and Luke, and a new sense that I had moved from a virus into a life-threatening situation which my combination of "underlying health conditions" just may not be able to cope with.

Within less than half an hour I was in intensive care, isolated in a room that looked like it was normally the area where staff monitored patients from. I had never felt so alone in all my life.

By midnight, I was busily convincing myself that I could well be dying and it was all my own fault. The thought of never seeing Tash or Luke again was simply unbearable, but in my mind and in fact, this was a realistic scenario that now existed.

I was being monitored by a team led by a senior consultant anaesthetist, who was asking me if I thought I could continue with the oxygen supply through my nose as a preferable alternative to full anaesthesia, intubation and being placed on a ventilator for an indefinite period of time.

Going onto a ventilator meant replacing my lungs with a mechanical breathing apparatus while disabling all my normal involuntary muscular activity involved with breathing.

After an hour I realised two things: firstly that my mental capacity to make what amounted to life and death decisions was by now seriously impaired and that I was incapable of making good decisions; and secondly that I was haunted by the fact that the second X-ray had been worse than the first, and so I was convinced that the current oxygen treatment was similarly not up to the job.

By 2am the decision was taken to "put me to sleep" and in a strange way I welcomed the ability to surrender all decision-making to these cool-headed, professional experts who knew much better than I did the risks I faced and trade-offs that were involved.

The process of being "put to sleep" was terrifying.

I was surrounded by medical staff, each with their own responsibility in the process, and all calmly and clearly directed by the senior consultant anaesthetist, who was pressing a face mask down on to my face with a force that made me feel that I could no longer breathe, while verbally reassuring me I was safe and would be taken very good care of.

I thought at the time that this could be the last I see of this life, and at the suggestion of the anaesthetist, thought of Tash and Luke for all I was worth, after which I remember nothing more of that night.

As it turned out, I was on the ventilator for approximately 36 hours during which time I remember nothing, but during which time I was kept alive by the skill of the medical teams and their sophisticated machinery.

I was brought out of the anaesthetic late afternoon on Tuesday 24 March and extubated (taken off the ventilator), and I can remember waking up, seeing blue sky through a window, and thinking "I'm still alive". I was in the high-dependency unit by this time, and just the presence of natural daylight had the most profoundly positive effect upon me.

My immediate thought was to get a message to Tash and Luke that I was conscious again and I made that request (almost certainly in much more garbled form than I credited myself with at the time) which was duly granted.

The other feeling I had immediately was that I felt less exhausted than I had been that Sunday night, and much more ready for the prolonged fight ahead.

I was on oxygen support for the rest of Tuesday 24th, overnight and into Wednesday 25 March.

By this time I was coughing up thick globules of blood and sputum which had accumulated in my bronchus as a result of the intubation.

This was a serious problem, because every time I coughed this horrible stuff up, it made me vomit as well, which was thoroughly interruptive of the oxygen supply which was so essential to my survival at this point; and for the medical staff because it exposed them to more pure COVID-19 infectious material.

To give an idea of how sick I was at this time, one indicator called CRP (C-reactive Protein) showed that my reading was 340, where a non-infected person's score should be minus 2.

My temperature was continuing to spike around the 40C mark (the point at which multiple organ failure can begin to set in), my blood saturation levels were poor, my blood pressure was "through the roof" (quote, unquote), and just about every other data point was out of whack.

Despite 36 hours on the ventilator, the virus was rampant within my body, particularly my lungs, and it was highly questionable whether I would make it through or not, with all my in-built disadvantages.

During the afternoon of Wednesday 25 March the team of consultants and doctors who were making collaborative decisions every hour made the decision to place me on CPAP support (continuous positive airway pressure) for however long may be necessary.

This involved a very tight-fitting face mask, through which a constant stream of pure oxygen is pumped directly into the lungs - in my case starting at 55 litres per hour.

I had two main concerns at this point: first, to keep breathing, and second, to try to suppress the coughing up of blood and sputum as I had no way of expelling it - the doctors told me I had to swallow it.

This was appalling to me, so we hit upon a compromise where I could use a thin suction tube to slide inside the CPAP mask without interrupting the flow of oxygen. This was more difficult and less practical than it sounds, and I soon found myself forcing myself to swallow the foul stuff, as I had been directed to. I was reminded of my defiant response "I'll do what I have to do".

Once the CPAP was started, I was on all sorts of medication. I had multiple cannulas in both arms, one in an artery, and one in my neck which allowed fluids to be poured down the back of my throat into my stomach - the water was okay, but the potassium was horrible.

But one of the medications was to reduce my level of anxiety, and so for the next 48 hours I became quite hallucinogenic as my mind was eased away from the drama of my situation, and so it started to float freely and at times bizarrely in all manner of directions.

During this 48-hour period, I found myself conversing with unknown others in a range of different accents from around the United Kingdom. Broad Scots, Northern Irish, Welsh, Geordie, Scouse, Cockney, Cornish - it was like taking a virtual tour of the UK and chatting with very amenable strangers who were full of good advice and encouragement.

And at times I would slowly descend into a sunny glade where people were relaxing, and as I got close enough to them to begin to discern their features, they vanished as quickly as they had appeared.

Other times I was floating in a circular motion inside a large natural bowl of thick green vegetation, but try as I might, I could never see the rim of the bowl and the sky above.

And all this time, the constant refrain of WHOOSH, HISS, WHOOSH, HISS, WHOOSH, HISS, dominating the weird version of consciousness that I found myself in. And a clear voice in my head then reminded me that I was fighting for my life.

It said that I was in the Staying Alive Factory, and that if I wanted to survive, I needed to stay on this noisy, uncomfortable, frightening production line; and that alternatively, if I fell off the production line, I would not make it through. So that was it.

Then the voice reminded me that I had a lot of explaining to do to Tash and Luke, and so I resolved there and then to remain on the production line - "I'll do what I have to do".

After approximately 48 hours on the CPAP, the same head of critical care came and asked how my breathing was.

The anti-anxiety medication must have been reduced or stopped by this time, because I clearly remember the conversation.

"Mmmch bttr," came my reply.

"Sorry, did you say your breathing feels better?" repeated the doctor.

"Much better," I forced out through the oxygen flow, the tight-fitting CPAP mask, and my by now completely dry mouth, throat and tongue.

I also felt instinctively that the industrial strength antibiotics they had been pumping through my body for days had finally got on top of the vicious bacterial infection in my lungs.

I had stayed on the production line, and I suddenly knew I could get past this. I could breathe to a depth that felt like it was self-sustaining (not actually quite the case at the time), and during the last few hours on the CPAP, I began to communicate by writing short notes on a clipboard given to me by one of the doctors.

One of the first notes I wrote was the question: when can I eat and drink something?

Within what seemed like a couple of hours, the CPAP was removed and replaced with a much gentler oxygen supply through my nose.

The instant calm that descended with the removal of the WHOOSH, HISS tyranny made me think I had moved from the main production line of the Staying Alive Factory to the body shop where, instead of destroying bad things and building back up good things, the focus moved to refined monitoring of what my body was able to do for itself again.

It was a beautiful day outside, that I could see from my bed. And it was a beautiful day inside my head, as I contemplated that I maybe would be seeing Tash and Luke again, and that my time had not yet come.

The rest, as they say, is history.

I was moved to Moreton ward, a convalescence ward where I was weaned off the oxygen supplies, given regular meals, and the recovery physio began. I was declared medically fit for discharge on Wednesday 1 April (an auspicious day if ever there was one), and I was reminded what a fool I'd been to play fast and loose with my health just to go on a skiing holiday. A mistake I will never make again.

Of course, there is no such thing as the Staying Alive Factory, which was an invention of my befuddled mind at a time of extreme health crisis.

What there is is the dedicated expertise, courage and commitment of the consultants, doctors, nurses, physios, Ancillary staff, and undoubtedly many, many others, of the NHS who collectively saved my life.

It may feel like a factory when you are undergoing such intensive care, but the key word here is care. It is to that care that I owe my life, and I will be forever grateful.