While visiting family in New York City over spring break, Dave Luce, his wife, and two teenage sons strolled through Chinatown, rode the subway around Manhattan, and caught a couple of Broadway shows before returning to San Antonio on March 17.
Three days later, he called his doctor about the tickle in his throat. Since he wasn’t coughing or running a fever, the doctor said he couldn’t be tested for coronavirus. “I called three other doctors and got the same response,” he said.
Another three days went by with no improvement, so Luce went to an urgent care clinic where he was prescribed antibiotics. Again, no coronavirus test. On March 23, he developed a fever and his doctor told him to go to the emergency room.
“My wife wheeled me into the emergency room and I think I must have just crashed after that,” Luce said.
He spent three weeks in the ICU before being released from the hospital, but that didn’t end his struggle with the debilitating effects of COVID-19. Luce’s story illustrates the journey – some of it spent in a rehabilitation facility – the most seriously ill patients face in recovering from a disease that leaves them so weak and short of breath that even taking a few steps is challenging.
The first thing Luce remembers about his long hospitalization came two weeks after arriving at the emergency room. He woke up angry in the special intensive care unit at Methodist Hospital in the South Texas Medical Center, tethered to an assortment of monitors and devices that were keeping him alive.
“I really didn’t know why I was there and it was extremely uncomfortable,” he said. “I had a tube up my nose and down into my stomach to feed me and all kinds of probes and IVs and wires and everything all over. I felt like Gulliver in Gulliver’s Travels.”
A nurse calmed him down, explaining to Luce that he had almost died. “I had to hit you with a defibrillator twice,” the nurse told him.
Once he was well enough to be discharged, doctors determined that Luce was too weak to go home.
“I couldn’t stand. I couldn’t walk. I couldn’t hold my head up off my chest,” Luce said. “I felt paralyzed from the neck down.”
He also missed his family terribly, not having been able to visit with them since he was admitted. “I wanted to go home and rehabilitate, but that wasn’t realistic of course.”
Luce was transferred to the rehab unit at Methodist Hospital Texsan about three miles away.
“Finally, after five weeks, I could shower and shave. That was a big step for me,” Luce said.
Then therapists took him to an exit door and pointed to a tall stairwell. “He said, ‘By the time you leave, I want to see you walk up those stairs and come back down,’” Luce said.
While his therapy began simply, with moving his feet and ankles in what Luce said seemed like silly ways, it soon progressed. In one exercise, he was asked to stand at a table and put together a child’s jigsaw puzzle. But it wasn’t about the puzzle – it was about learning to stand.
Texsan was the first hospital in San Antonio to care for patients with COVID-19 when cruise ship passengers exposed to the virus were flown to Joint Base San Antonio-Lackland for quarantine in February, and some became sick.
“We were, early on, looking at what does this mean to care for COVID patients, learning daily all kinds of different pieces of information about how to care for these patients,” said Pam Kane, director of rehabilitation services. About a month later, as more patients were hospitalized, the Methodist Hospital system transferred its COVID unit to the main hospital in the medical center.
“Some of those patients were in the hospital for a very long time – you’re talking about three or four weeks of hospitalization, which is pretty much unheard of these days,” Kane said.
As the patients improved, however, physicians realized they couldn’t go directly home. “They don’t have any strength. They can’t breathe very well. They get short of breath very, very quickly just by taking a couple of steps,” Kane said.
Those patients are now transferred to Texsan, which has provided rehab treatment to two of the sickest COVID-19 patients so far.
Not every patient needs inpatient rehab care after leaving the ICU and much depends on the patient’s ability to maintain oxygen levels, Kane said. But while patients receive physical therapy while in the ICU, it’s not as intense as the kind of inpatient rehab care provided in a rehab setting.
“It’s really interesting because this disease is still so hard to understand,” she added. “We have a lot of variety in the people that are contracting it. Some people have a lot of pre-existing conditions and some people have zero. Some people have very light symptoms or no symptoms, and some people immediately go on a ventilator and cannot get off of it. Some people die.”
Kane also said that health insurance providers have been more readily authorizing rehab care lately as they recognize the value of moving patients out of critical care settings and getting them home sooner.
For Luce, rehab started very slowly, she said, as therapists monitored his oxygen and blood pressure levels.
A week into his therapy, when therapists asked Luce to move his feet back and forth, he responded that he may as well be doing the salsa. When they put the music on, Luce was dancing.
The goal was to get him strong enough to return to his job as a barber at Arcadia Hair Studio in Alamo Heights, where he has worked for 20 years. Thus, the puzzle exercise helped him develop muscles to stand for longer periods of time. He also learned to climb the stairs.
“On May 6, I got to go home,” he said. Barber shops and salons were allowed to reopen May 8. But Luce needed more time to recover and continued his therapy at home. He was able to return to work in early June.
As he continues to build strength, Luce has kept up a walking regimen, making it up to three miles at a time on the Leon Creek Greenway Trail using an antique cane to steady himself. He also wears a face mask.
“It kind of scares me when people have [an anti-mask] attitude, especially knowing what I know now,” Luce said. “I was a little cavalier about the whole thing when I first went to New York. But I kind of paid for that nonchalance.”