The Meaning of Care Magazine
Nebraska's First COVID-19 Patient: The Day Methodist Entered the FightPublished: Nov. 25, 2020
Nothing Emma was feeling worried the Hutchinsons. Not only did Emma have a history of migraines, but she also was susceptible to respiratory infections due to a partially paralyzed vocal cord. Even when her primary care provider diagnosed her with a cold on March 2, it was nothing unusual.
After checking the accuracy of Emma’s blood oxygen level, Dr. McMahon ordered a chest X-ray. Ralph gave Emma a hug goodbye. He’d come back when she was ready to go home.
“That was the last time I saw him for a month,” Emma said.
That’s also where Emma’s memory ends until she woke up from a medically induced coma weeks later at Nebraska Medical Center. When her chest X-ray was consistent with pneumonia, Dr. McMahon asked her if she’d traveled anywhere. She had. Emma and Ralph had recently visited London to celebrate her grandfather’s 100th birthday. Dr. McMahon’s thoughts turned to COVID-19, but the United Kingdom wasn’t on the travel advisory list. Emma wouldn’t qualify for testing with the Douglas County Health Department.
Dr. McMahon started the process of admitting her to Methodist Hospital for further testing. Charge nurse Tony Opitz, BSN, RN, vetted Emma like any other potential admission. When he saw that she had pneumonia-like symptoms and a history of international travel, he had the same suspicions as Dr. McMahon.
“It just seemed like there was something more there,” Opitz said. “All the news about COVID-19 was in the back of my mind.”
He called infection preventionist Amanda Wyant, MSN, RN, who wanted to get Methodist Hospital infection prevention medical director Robert Penn, MD, involved. Dr. Penn looked at Emma’s chart and was intrigued.
“We all had the same feeling: ‘Looks like a duck, sounds like a duck, but they don’t have the color yellow listed on the screening tool,’” Wyant said.
Recently published medical journals had shown the effectiveness of CT scans in indicating COVID-19, so Dr. Penn encouraged Dr. McMahon to order a scan. Then he asked Wyant to secure a COVID-19 test. At first, the health department resisted – the U.K. wasn’t on the screening tool. But when Wyant said Dr. Penn was making the request, they agreed.
The COVID-19 test result wouldn’t be available until the next day, but the CT scan was consistent with the disease. Emma likely had the virus, and she was quickly declining. She was transferred to Methodist Hospital for further care and to await her result.
An Anxious Wait
Before Callie Fuhs, BSN, RN, started her overnight shift in the progressive care unit on March 5, the virus felt far away. But when she found out the unit had a suspected COVID-19 patient, she volunteered to care for her.
“I looked at all my coworkers, and I was the only one who didn’t have kids,” she said.
Dr. Penn was confident Emma had the virus, but it didn’t feel real to Fuhs until the hours ticked by and they increased Emma’s oxygen more and more.
Meanwhile, Methodist Incident Command opened as the system braced for potential cases, and discussions began with Nebraska Medical Center to transfer Emma if she tested positive because it had a clinical trial for the antiviral medication remdesivir.
“We wanted to see if Emma would have access to that,” said Bill Lydiatt, MD, vice president of medical affairs and chief medical officer at Methodist Hospital and Methodist Women’s Hospital. “That’s why we transferred her.”
Emma made it through a challenging night. In the morning, Fuhs was replaced by Lauren Jaworski, BSN, RN. Like Fuhs, in order to minimize exposure, Jaworski was the only one in the isolation room with Emma for long periods of time, performing duties that might otherwise be done by others on the care team.
In the afternoon, Wyant received the call they’d been waiting for. Emma was positive for COVID-19. Nebraska had its first confirmed case.
What followed happened quickly: phone calls with the health department and governor, coordinating the logistics of the transfer, investigating potential exposures from Emma’s visits to the ED, media reports that Methodist Hospital had a confirmed case. And someone still had to tell Emma she was positive.
“I had pulled the recliner up to her bed,” Jaworski said. “I was sitting, holding her hand and watching ‘Friends,’ and that’s when somebody told me her result. And so I told her because I was in there with her.”
Jaworski said it took time for Emma to process the news. All she could do was keep her calm.
Pulmonologist Christopher Shehan, MD, decided not to intubate Emma before her transfer. She was on a BiPAP machine to push air into her lungs, but she was stable. When the ambulance arrived, Jaworski and Dr. Shehan assisted in getting Emma in the isolation pod where she would remain for the transfer.
Emma was gone from Methodist. But her fight was only beginning.
A Fighter and Survivor
Emma wouldn’t return home until April 4. When they heard the news, those involved in her diagnosis and care at Methodist were elated.
“I’m so happy she was able to recover from this,” Fuhs said. “She really worked hard all those weeks.”
“It was encouraging to know somebody could get so sick and recover,” Dr. Penn said. “She was at risk not only for severe disease but of dying from this infection. It started with the Women’s ED – the care they gave her. All those initial steps translated into her surviving this.”
Both Dr. Penn and Dr. Lydiatt credit Methodist’s teamwork and the multidisciplinary care Emma received.
“I was awestruck by how people dived in and did the necessary work, whether it was Incident Command or the nurses and physicians caring for Emma,” Dr. Lydiatt said. “No one stood back.”
Ralph is grateful to those who acted on their instincts and knowledge of an unfamiliar threat to get his daughter the care she needed at a critical point in her disease.
“We could have gone home that night, and that could have been it,” he said.
Today, Emma is taking life one day at a time and is especially thankful to Dr. McMahon for noticing something was wrong on March 5. She’s learned to be patient with her recovery and hopes she can inspire those suffering from any disease to stay the course.
“She’s a fighter,” Ralph said.
And now, she’s a survivor.
Photos by Daniel Johnson