As more COVID-19 patients ended up in UnityPoint Health-Meriter’s intensive care unit last week, most hooked up to ventilators to help them breathe, Dr. Matt Nolan noticed something different from his regular critical care patients.
Many of those infected with the new coronavirus were not elderly. They didn’t have chronic diseases. Before the virus left them clinging to life, they were healthy.
“It’s a little scary as a young, otherwise healthy person myself, thinking about that for me and my family,” said Nolan, 35.
At home in Madison, he began sleeping in the basement to protect his three children, ages 6, 3 and 1. His wife, Dr. Maggie Nolan, 37, wonders if he will need to move to his own apartment as his potential exposure to the virus increases.
“It seems inevitable,” she said.
Matt Nolan misses the comfort of close contact with his family. “We’re giving each other air hugs now,” he said.
For workers on the front lines of the COVID-19 pandemic, the risk isn’t theoretical. They see lungs filled with fluid on chest X-rays. They care for seriously ill people who aren’t allowed to have family or friends visit, as is normally the case. Despite wearing face shields and masks and gowns and gloves, and taking other precautions, they’re inches away from patients emitting a new virus that has killed more than 55,000 people worldwide and for which there is no cure.
“There’s always this concern that, despite doing all the right things, you still could have contaminated yourself in some way,” Matt said.
As a UW Health critical care specialist and pulmonologist — a doctor who focuses on the lungs and the respiratory system — Matt Nolan was the main doctor in Meriter’s ICU last week and on call there one night this week. Last week started off slow but ended up busier than usual over the weekend, when more than half of the patients in the 18-bed unit were struggling to overcome COVID-19, he said.
Most of the patients have acute respiratory distress syndrome, in which fluid fills tiny air sacs in the lungs. On a chest X-ray, “both lungs turn into a white-out,” he said.
To help them breathe, doctors take two seemingly counterintuitive steps: They set ventilators lower than normal and flip patients on their stomachs, sometimes using drugs to paralyze their muscles.
With liquid replacing much of the air in the patients’ lungs, the lungs shrink, making them less able to tolerate high pressure from a breathing machine, Matt Nolan said. If patients lay prone, the fluid doesn’t pool as much and the heart doesn’t push on the lungs, he said.
Some patients receive anti-inflammatory medications and some get anti-virals, including drugs such as chloroquine, which is approved for malaria and has shown some promise, but no conclusive evidence yet, against COVID-19.
But mostly, “it’s really just supportive care,” Matt Nolan said.
‘Because the virus’
Maggie Nolan, a resident in UW-Madison’s preventive medicine program, is also playing a role in fighting the pandemic. She is part of a team that plans to advise the state on how to allocate ventilators and other critical care resources if there aren’t enough to go around amid a potential surge of COVID-19 patients.
“(Matt) is on the front lines. I’m kind of in the background,” she said. “We’re kind of working together because he’s going to be the one ultimately affected by the work I’m doing.”
Raising three young children as a doctor couple is never easy, though the Nolans have a nanny on weekdays who continues to care for the children during the outbreak.
But when Matt came home Sunday night after working in the ICU all weekend, they decided he should seclude himself in the basement. He’s also been changing clothes before leaving the hospital, leaving his shoes outside their house and showering right after entering.
“The kids are confused,” Maggie said. “He can’t hold them. He can’t touch them. He can’t put them to bed. We can’t go downstairs where daddy lives.”
Their 3-year-old son, Condict, is starting to catch on. “His favorite phrase is, ‘because the virus,’” Maggie said. “He applies it to everything now. We can’t go outside right now? ‘Because the virus.’”
Last Saturday was their daughter Charlotte’s sixth birthday. She couldn’t invite friends to celebrate. Matt was in the ICU. Maggie’s mother, who often visits from Minneapolis for such occasions, stayed away to protect her health.
“It’s really hard,” she said. “It’s been a lot.”
Matt’s ICU stints of working seven days in a row, including one night on call, usually come once every six to eight weeks. But with more COVID-19 patients requiring critical care, he will likely be needed there more.
“He’s going to be kind of absent for this period of time, however long it takes,” Maggie said.
Matt said Meriter and UW Health are doing everything they can to protect workers and prepare for a potential onslaught of patients. He is feeling well and stayed in his basement after his ICU stint out of an abundance of caution, he said.
Most providers caring for COVID-19 patients wear face shields and N95 masks, but he is using a device called a powered, air-purifying respirator because his beard prevents a tight seal with an N95. The hood-like, battery-powered respirator includes a hose through which filtered air is pumped.
Despite the protection, he spends a fair amount of time in close proximity with patients whose serious symptoms make them more contagious. Any sniffle he has, any hint of fatigue, makes him wonder.
“Everyone is becoming hyper-vigilant about any little symptom,” he said. “Walking into it every day is tough.”
Madison — unlike hard-hit places like Seattle, New York City, Detroit and parts of Louisiana — has had time to prepare for an influx of COVID-19 patients, he said. On many of his days away from the ICU, he’s in meetings discussing the latest word on treatments and protective equipment.
“As much as you can be in a pandemic, we’re ahead of the curve (here),” he said. “I feel like we’re ready. As best we can with the supplies we have, we’ll be able to deal with this.”
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