A Young Doctor, Fighting for His Life
“I just went down on my knees,” his mother recalled later. “I just implored God for mercy.”
By Nicholas Kristof Opinion Columnist
A 27-Year-Old Doctor’s Fight Against Coronavirus
Dr. Andres Maldonado was on the front lines treating patients. Then he got sick too.
Transcript of video:
A few weeks ago, I visited two hospitals in the Bronx to report from the front lines of this pandemic. While there, I kept hearing about a young doctor with Covid who was fighting for his life in the ICU. Things just were not getting better. The amount of anger and frustration and sadness that I felt. Just the idea of losing my son was unbearable. But ultimately, he survived. I’m Andres Maldonado, and I’m an ER doctor here in the Bronx. I’m a healthy 27-year-old guy. No medical problems. But I got Covid-19. I was so sick that, at one point, I thought I was going to die. This is my story, which should be a warning to everyone. I was working mostly in the two weeks where it was really starting to ramp up. It was quite dire. Stretchers lined two or three deep. You were just being called from one patient to the next. “I need a vent.” “I need a vent.” How many vents do we have? All these questions that we had never considered, ever. They’re starting to ration out these N95s. We’re in a spot where we’re wearing stuff a day at a time, multiple days at a time. A lot of these patients that I’ve met are scared. I want to be able to help people when they need you the most. There was a patient, and she coughed right on my face. And that’s when I got scared. What if she does have coronavirus? Day one, March 23rd. It was the middle of the night. I started to feel just really horrible chills. But I thought to myself, oh, you know, I’ve been sick like this before. You know, I’ve had a virus. I’m young. I’m 27. I’m invincible. Like, you know, nothing can touch me. Day two. When I would take a really deep breath, it would hurt. Day three. Fevers that would come up to 102. But I would take Tylenol, and I’d be OK. Day four. I spoke to my mom. Through the whole week, it was like, what’s going to happen, what’s going to happen? Day five was actually when I went to go get tested. Day six, and my coronavirus is positive. Our worst fears were coming true. Day seven. I was pacing my room, and I was just thinking, come on, Tylenol, just start working already. It worked a little bit, but then the fever would come back two hours later. Day eight. Couldn’t finish my sentences without taking a breath. That’s when it clicked, I can’t continue to stay home. Day nine, March 31st. Andres calls me, and he tells me, the first thing is, ‘Mommy, don’t panic.’ And when he says don’t panic, what do you think I’m going to do? And he goes, ‘I’m going to the ER right now. I don’t feel good.’ And I said, ‘what’s wrong?’ And he said, ‘I’m short of breath.’ I met Mike Jones, our leader in residency, inside of a tent in front of the ER. He came to the hospital where I was that day. Every patient with COVID reaches a critical time period where you can see that they’re heading in the wrong direction. They’re kind of going over that tilt of that cliff, heading in the direction where they may need intubation. At least 70% to 80% of patients who were placed on ventilators were dying. So we tried very hard to avoid intubation. Everyone who was there knew me. All the nurses, Mike Jones. I know Dr. Romo personally. They were alarmed. Just looking at him through the window, it just felt like I got kicked in the stomach. I ended up writing ‘we love you’ and taping it on the window so he could see it. I went in the room and I cried. I cried. I wanted to remain strong and support Andres, and not let him see that I was worried. I was terrified. When I walk into the room, I realize that he was breathing at a faster rate than he was before. That was a significant moment for me because I have been in that position where you see a patient, they were critically ill. I knew that sense of urgency meant that they were considering more invasive options. We decided that he was getting sicker, and that maybe he was going to need to be intubated. We made the decision to admit him to the intensive care unit. I said, ‘call the ICU right now. Let them know he’s coming.’ I heard Dr. Romo say he needs to be placed on a high-flow nasal cannula. A device that provides a large volume and high velocity of oxygen to a patient. So we brought him right up and started the high-flow nasal cannula. The only thought in my head was, just please get better on this. Please, please work. I woke up in the middle of the night. I heard a lot of commotion outside, and people turned on all the lights. I looked at the monitor to check my vital signs, and overhead, you hear— “Rapid response. Rapid response.” They’re calling for extra doctors to report two rooms down from me. She was a 25-year-old. She just kept saying, ‘I can’t breathe, I can’t breathe.’ Then she had this cardiac arrest. Her heart stopped. And I was terrified. You know, I was thinking, that’s two doors down, and that could have been me. Sometimes, you think about what would happen if you would die. And then you think about your parents if you died, the permanent distress they’d probably feel. And I haven’t really seen my husband cry, and he did break down. I have never seen him like that. He went on his knees, and he was asking God to please save Andres and take him instead of Andres. My dad doesn’t get like that. You know, he’s serious. He’s like a military guy. Just let me get over this. Just the idea of losing my son was unbearable. Despite thinking I can die, I still felt determined to somehow get better. And the way that translated to me and my medical mind was focus on your breathing. One breath at a time. Think about the air going in, out. Try and take deep breaths. Makes you cough? OK., take a break. Try again. And then at some magical point, we turned the corner. What’s up, Andres? Welcome back. Hey, thank you. Wow. [CHEERING AND APPLAUSE] (CHANTING) Andres! Andres! Andres! Andres! Andres! Andres! Andres! Andres! Andres! Andres! I’m completely overwhelmed right now. It’s a victory. Every victory helps us try to help the next patient get through this. It was an amazing feeling of triumph. It was like, yes, we did this, we beat it. They saved my life. 24 of our 84 emergency medicine residents have been out sick during this crisis. The number of health care workers that have died is horrible. All health care worker infections are preventable. I really, truly believe that. I believe the government failed everybody. Oh, only 400 died today, not 700 like last week. It’s like, for goodness sake, we’re talking about human lives. It’s a virus. It will infect you. It doesn’t care who you are, where you’re from, what you do, who you support politically. It just doesn’t care. Please appreciate your life more before you choose to ignore the stay at home orders or the quarantine, because anyone can get sick.
Back to story:
Dr. Andres Maldonado normally bounded into the Emergency Department, fit and vigorous, but this time he had to be escorted in, pale and fighting for breath, with a patient bracelet on his right wrist. A nurse, seeing her colleague struggle, burst into tears.
Maldonado was 27, a third-year resident physician with no underlying medical conditions. When he came down with a fever on March 23, he called in sick. Soon he developed a tightness in his chest and tested positive for the coronavirus.
At first he resisted the idea of seeking treatment. He was by nature stoical; in youth soccer games, other boys had crumpled when injured, but Maldonado always got up and limped through his pain. Now as a doctor — a badass emergency doctor, he jokingly called himself — he was humiliated by the thought of becoming a patient.
But on March 31, so out of breath he could barely get to the bathroom, he called his older brother, Nestor, also an emergency physician, who remembers panic in Andres’s voice.
“It hurts to breathe,” Andres told his brother. “My body aches all over. I’ve been having really bad fevers, and I’m getting, like, dizzy.”
“Yo,” his brother ordered him, “get your butt to the E.R.”
Maldonado called his parents to say that he was going to the hospital. His dad, Jose Maldonado, was a refugee from the civil war in El Salvador who started life over as a dishwasher in New York. His mom, Cecilia Aguilar-Maldonado, came from Ecuador, and both were undocumented for a time — yet they sent both sons through medical school. The parents were the first of many to be devastated by their son’s sickness.
“I just went down on my knees,” his mother recalled later. “I just implored God for mercy.”
She told her husband, and he began crying as she had never seen him cry before: “He was asking God to please save Andres and take him instead.”
Maldonado called ahead to the Jacobi Medical Center, one of several hospitals in the Bronx where he worked, and doctors there were waiting for him and gave him a room in the Emergency Department. Kelly Cabrera, a nurse who often worked beside him, spotted him and was puzzled.
“What are you doing here?” she asked. Gasping for breath, he explained that he had Covid-19.
“I tried to stay home,” he told her, embarrassed that he was giving his colleagues more work.
“I got kicked in the stomach,” Cabrera recounted. “He was one of our own.”
Cabrera and the other nurses, all of whom knew Maldonado well, took blood and gave him oxygen and Tylenol. Several scrawled a big message and placed it on the window facing him: “We Love You.”
Cabrera stepped out, weeping and also cursing. “I felt incredible anger,” she said — at America’s lack of preparation for the virus, at shortages of protective equipment, at official dithering that had left Maldonado and other medical workers at risk. At least 145 health care professionals have died of Covid-19 in the United States, according to an unofficial list kept by Medscape.
Doctors in the E.R. saw that Maldonado’s condition was deteriorating. A new wave of fever swept over him, and he curled into a ball. His heart rate shot up to 130, and he was taking 35 breaths a minute, more than twice his normal rate. He couldn’t finish a sentence without running out of air. The doctors decided to rush Maldonado into the intensive care unit and put him on high-flow oxygen.
Maldonado had been sharing his lab results and X-rays with his girlfriend, Dr. Katherine Auwarter, an ob-gyn resident in Greenville, S.C., and now he texted her that he was being admitted to the I.C.U. She called immediately.
“I’m being admitted,” he told her weakly, and his voice broke. “I’m so scared.”
“I’m going to buy a plane ticket right now,” she told him. And then, she said, they both broke down.
She knew that what terrified Maldonado most was intubation and attachment to a ventilator: He knew that a great majority of patients intubated for Covid-19 never recovered. Doctors hadn’t directly raised with Maldonado the possibility of intubation, but he could see his oxygen levels slide — and his doctors kept an intubation cart outside his room, just in case.
When a patient is transferred from the E.R. to another floor, an orderly and a nurse typically roll the stretcher there. In this case, the Emergency Department staff gathered to wish him well, and two attending physicians and a nurse together pushed Maldonado’s stretcher to the I.C.U.
Doctors tried to smile reassuringly — but it was a front.
“I was terrified,” recalled Dr. Michael P. Jones, the head of the resident program. Jones went back to his office, closed the door, lowered his head on his desk and cried.
In the I.C.U., Maldonado was placed on a high-flow nasal cannula to force oxygen into his lungs. These devices have a good record of helping Covid-19 patients but are in short supply, and not all American hospitals have them.
His doctors believed that his life was in danger partly because of his body’s own immune response, creating a cytokine storm attacking the vital organs. Doctors proposed using an experimental drug, tocilizumab, to suppress his immune response. This has sometimes been used successfully with coronavirus patients but can also cause serious side effects; feeling desperate, Maldonado agreed.
The next day he was breathing a bit better, and the fever was gone. Slowly over several days his lungs cleared. After six days, he was discharged. The residency program insisted that he take two weeks to recover, and he used the time to reflect on life and the practice of medicine.
When he was in the E.R. as a patient, he had wanted to go to the toilet but couldn’t walk that far, and he was mortified at the thought of using a bedpan and having a nurse wipe his bottom. So he held it in, learning empathy for patient concerns that is difficult to teach in medical school.
He now urges people to be careful and to stay home. “I hear your frustration,” he says of those protesting to restart the economy, “but what good is all the things you’re protesting for if you’re dead?”
Another lesson: Don’t be a stoic and delay seeking help when it’s necessary. “The key to all of that was the early initiation of the high-flow nasal cannula,” said Dr. Noe Romo. “Andres was at the point where if we had waited a little longer, I don’t think the high flow would have been as effective.”
I tagged along on Maldonado’s first day back on the job recently. This was at Jack D. Weiler Hospital, and 50 of his colleagues turned out for a surprise celebration. They cheered, clapped and shouted his name.
He beamed. “I feel even more than ever that this is what I should be doing, that this is my calling,” he told me. “Maybe I got sick for a reason.”
One of his patients was a Central American woman in her 30s with the coronavirus, fear radiating from her eyes. Maldonado spoke to her in Spanish, asking medical questions but also reassuring her and telling her about his own brush with the virus.
“You know, I was in the intensive care unit,” he told her, adding teasingly, “If I got better, you have to get better, too!”
“Thank you,” she said, “for telling me that.”