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Buffalo News: Buffalo General patient gives his first hand experience in ICU with COVID-19

Updated: 5/5/2020
Ivan Gonzalez hugs his wife, Colleen, after being discharged from Buffalo General Medical Center. (Mark Mulville/Buffalo News)

His lungs gave out. Nightmares kicked in. But he's home for his son's birthday

By Tim O'Shei
Published 5:00 a.m. May 5, 2020

Colleen Gonzalez waited in the lobby of Buffalo General Medical Center. She hadn’t seen her husband in 34 days. Nearly five weeks of wondering and hoping were about to end. Any minute, the elevator doors would open to reveal a nurse pushing Ivan Gonzalez in a wheelchair.

This was discharge day.

But it didn't end Gonzalez’s battle against Covid-19, one that began in mid-March with what he thought was the flu. Gonzalez, who is 52, would be coming home with an oxygen tank that he would still need to use at night, and with less strength and energy than he had several years ago, when he was running marathons, or even seven weeks ago, when he was still teaching English in a Buffalo high school.

But his hospital stay was ending – and so might the tears. Tears that the couple's son, Milo, who turns 3 on Sunday, wouldn’t allow, anyhow. Colleen Gonzalez's mornings and evenings for the last five weeks have been bookended by calls to this hospital, always emotional, often discouraging. Ivan Gonzalez nearly died here.

Milo was with her for most of those calls, and if she got upset, he would say, “Don’t cry, Momma. Be happy!”

The elevator doors opened. She saw her husband.

“There he is,” she said, her eyes revealing a smile beneath her mask.

Ivan Gonzalez didn't die here. He was saved here.

'People aren’t just getting better'

I met Ivan Gonzalez eight days earlier when Buffalo News photographer Sharon Cantillon and I toured the intensive care floors at Buffalo General. That visit was one of three we made that week to Buffalo hospitals where patients with Covid-19 are being treated. The others were Erie County Medical Center and Catholic Health’s Covid-19 treatment facility. We donned personal protective equipment and walked the medical intensive care units – or MICUs – to chronicle up close the fight waged by patients and their doctors and nurses against the toughest cases of the disease spreading through this coronavirus pandemic.

Most people who contract Covid-19 are not hospitalized. But for those who are, like Gonzalez, the fight is daunting. Consider these numbers, which were accurate during our visits in the last full week of April and have certainly grown since:

• ECMC had 41 patients who tested positive for Covid-19, 21 of whom were on ventilators. The hospital had discharged 44 people and had 17 Covid-19-related deaths.

• Catholic Health System had 80 patients at its Covid-19-only facility, where workers also began a practice of placing small electric candles in the chapel each time a patient died. On the day we visited, there were more than two dozen candles in the chapel, where workers often go to pray. Across Catholic Health’s five hospitals, there had been 243 discharges and 72 deaths.

• Buffalo General, which is run by Kaleida Health, had 58 patients with Covid-19. Seventeen of them were on ventilators. The hospital had discharged 214 patients and had 32 deaths. Kaleida also provided numbers for its Williamsville facility, Millard Fillmore Suburban Hospital: 22 patients with Covid-19, five on ventilators, 172 discharges and 36 deaths.

The numbers reflect the intensity of Covid-19 at its worst. It attacks the respiratory system aggressively, which can lead to fast crashes of patients’ oxygen levels, followed by long stretches of time breathing with the aid of a ventilator.

Dr. Ravi Desai, director of pulmonary medicine at ECMC and the associate director of that hospital’s MICU, called it “a devastating disease.” Speaking in broad terms about Covid-19 patients in critical care, he pointed out that most who make it home will still have a formidable battle in recovery.

“Unfortunately, people aren’t just getting better,” Desai said. “The vast majority are going to need long-term medical care.”

During our visits to the three hospitals’ intensive care units, where the rooms have glass doors that allow you to see in from the outer area, Ivan Gonzalez was one of the only patients I encountered who was alert and chatty. When we first walked by his room, he had a quick conversation with Dr. Lucy Campbell, the MICU medical director and one of the attending physicians who had overseen his care. At this point, Gonzalez had been in the hospital for 26 days and was already through the worst.

“He could have very easily died,” Campbell told me later. “He was very critically ill and many things could have not gone well.”

But at this point, Gonzalez knew he was heading home, and only hoped that he could make it in time for his son's birthday. I asked if I could speak with Gonzalez and if he would agree to be photographed. He said yes. A hospital staff member sent in a clipboard with a consent form and pen, and I noticed the act of filling it out was tiring for him. He was still weak and his voice was shaky. Before our interview, a nurse stepped into the room to give him a shot in the stomach. But Gonzalez had a sense of humor — he said something to me about putting on a space suit before I stepped into the room to speak with him.

He was joking about still being contagious with the coronavirus.

The nick of time

Gonzalez, who teaches English at Buffalo Academy for Visual and Performing Arts, said he had been thinking about his mortality for most of this year. In February, he was driving on a city street to a hockey rink to play a 6 a.m. game when a tree dropped on top of his car. He was OK, but the experience shook him.

Gonzalez, who teaches English at Buffalo Academy for Visual and Performing Arts, said he had been thinking about his mortality for most of this year. In February, he was driving on a city street to a hockey rink to play a 6 a.m. game when a tree dropped on top of his car. He was OK, but the experience shook him.

“I was thinking, ‘Hey, life is short — there are no guarantees,’ ” he said from his hospital bed. “So needless to say, that put me highly conscious about this.”

“This” is the virus. In late winter, Gonzalez started noticing “corona” memes and jokes online, but also was reading stories that weren’t funny at all. “Nah,” he thought to himself, “these things are real.”

It became real on a Tuesday in mid-March after schools had closed. Students were able to come to the building to pick up packets of work, and that day Gonzalez was shivering. He went home and told Colleen, “I don’t feel so hot,” and she told him to lie down. He stayed in bed for the next two or three days, chugging Gatorade, not feeling better.

“I’m one of those guys who tries to tough everything out,” he said. Right then, a blood pressure monitor started humming in his hospital room. “My blood pressure is always high,” he said. “It’ll start beeping in a minute.”

On cue, the beeping began. Gonzalez may be one of those tough-it-out guys, but he’s realistic about his medical issues. He began running marathons in his 40s as a way to try to address his blood pressure issues. When he got sick in March, he followed his wife’s urging to see the doctor.

This seems to be a trend among patients with highly acute cases of Covid-19.

“I will tell you this: It's usually the wife who has finally gotten the guy to come in,” Campbell told me later. “And it's usually just in the nick of time.”

'Nightmarish experiences'

Gonzalez was admitted on March 26. Doctors quickly put him on a ventilator, and over the next couple of weeks, employed a series of treatment techniques and medications to keep him alive and give his lungs the chance to recover. He was sedated heavily and, because his condition was so dire, put on medication that induces paralysis, which allows the ventilator to do its job.

Gonzalez was put in a “prone” position – lying flat on his stomach for up to 16 hours a day – to take pressure off the tissue in the back of his lungs and maximize his opportunity to breathe. He was given medication to avoid blood clots and ulcers. His body went into septic shock, causing his usually high blood pressure to drop dangerously low. His kidneys were damaged, but recovered. Antibiotics helped stave off a bacterial infection in his lungs.

Doctors took Gonzalez off the ventilator on April 12, but had him back on it after 36 hours. Later, they added a second ventilator — this one made of hard plastic and shaped like a turtle shell, with foam around the edges. While the traditional ventilator pumped air into his lungs, the second one fit over his torso and used negative pressure to suck his chest outward when he took a breath. The combination of the two helped his lungs recover to the point where he could breathe without the help of the machines.

“I would not have been surprised if we were unable to save him, but I'm very glad that we did,” Campbell said. “And it absolutely took the entire team.”

The treatment worked for Gonzalez, but the combination of sedatives, isolation and the invasiveness of ventilator tubes and other equipment create a harrowing psychological effect. Medical professionals often refer to this as “ICU delirium.”

Gonzalez calls it “nightmarish experiences.”

“I couldn’t tell what was a nightmare and what was a reality,” he said, and then offered a view into it, with a disclaimer: “It’s kind of odd.”

He continued: “It felt like I was in a bag of plastic body parts with moaning corpses and things grabbing at me. All of a sudden somebody was shaking me out of that and saying, ‘Hey, you’re at Buffalo General!’ That was that freaky, drug-related response. I would be afraid to go asleep, and next thing you know — BOOM. I’m with the moaning corpses again. I kept waking up in different places. One of the nurses resembles one of my old high school friends, and I started thinking, ‘Why is he trying to kill me?’ I thought I was being harvested for body parts or something.”

Later, when Gonzalez was lucid and heading toward recovery, he saw that familiar-looking nurse walk by. The nurse wasn’t actually the person Gonzalez knew from high school, but they met and chatted.

“Great guy,” Gonzalez said. He knows this nurse was one of the people who helped save his life.

On the afternoon of April 29, it was time for Gonzalez to go home. Colleen greeted him with that tender phrase: “There he is.”

Ivan Gonzalez, dressed in jeans and a gray T-shirt from the University at Albany, where their eldest son attends, stood and hugged his wife. “Nice mask,” he said, noticing her black-and-white polka-dot face covering.

He looked tired.

“Is he able to walk?” Colleen Gonzalez asked the nurse, who said he was. The nurse handed her the oxygen tank he needs to use at night.

Ivan and Colleen Gonzalez wrapped their arms around each other’s shoulder, leaned in and walked out.