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In the ‘Covidomania’ atmosphere that has been prevailing for over five months, anything from a headache, or a singular sneeze, to a cough reflex is construed as a ‘COVID-19–related’ symptom. Added to this is the stigma and discrimination meted out to those infected, in life, and even after death. Living in a family in which four in six are doctors has advantages but can also be challenging. Apart from me, there are my daughters — one is an infectious diseases specialist and a frontline COVID-warrior, and the other a microbiologist — and my elder son-in-law is a radiologist. Whom else could you call upon to rapidly suspect COVID-19 and suggest a plethora of remedial steps when dad gets symptoms? In addition to the COVID-19 scare, we had a number of events: my younger daughter delivered on April 18, and her elder sister, who was carrying full-term, delivered on August 15. My younger son-in-law, a banker, has been working from home. We have all been locked in since March 20.
Naturally, I preferred to self-diagnose and self-medicate when I didn’t feel well!
Last month (months after my now irrelevant travel history in February-March to Australia and Indonesia), I got fever with shaking chills one night. Having noticed a number of mosquitoes around, I suspected malaria and started popping anti-malaria pills, without telling my wife. Last year, I had suffered from Chikungunya and overcome its debilitating consequences with great determination, physiotherapy and family support, but also taking lots of homeopathy and HCQ (Hydroxychloroquine) for a considerably long period of time. I did presume some immunity to the Coronavirus was natural, as suggested by the wide-ranging discussion on HCQ effects on COVID-19 prevention and inclusion in our national guidelines.
The next day, I self-tested for malaria, dengue and chikungunya with complete blood counts. All the test results were negative. Being familiar with tests and lab reports as part of her patient-counseling and supervisory stint at the clinic, my wife added the Erythrocyte Sedimentation Rate (ESR) to the testing profile. We were astonished when it was 120mm per hour (the normal range is up to 15 for an adult male).
My low-grade fever continued, rising in the evenings. Headaches and night sweats started. Then a mild dry cough got added to the list. Now I self-diagnosed myself for another condition: Tropical Eosinophilia. And started Diethylcarbamazine to cure it. I did take my younger daughter into confidence.
Another round of blood-letting followed along with an IgE test to look for any allergies. By then, I had reached the last, frightening test milestone! Under pressure from my caring but increasingly anxious family, we ran an array of tests, including for COVID-19 as well as a thyroid test. Nothing conclusive. And the thyroid reports were awaited.
Loss of appetite, 4-kg weight loss and, literally, a pain in the neck. The fever continued leading now to a suspicion of tuberculosis. Radiology and blood tests followed. Given my age of 62, malignancy was also considered. By now all three ‘family’ doctors were fully involved, and had started discussions in their respective specialty circles. Ace radiologist Dr. Bhavin Jankharia suggested a full-body PET/CT scan with a thyroid radio-uptake study the next morning, followed by a COVID-19 RTPCR test. In a new development, I noticed a painful swelling in the thyroid region and as test results for the Thyroid Stimulating Hormone (TSH) were very low, it was suggestive of acute thyroid inflammation. That was the saving grace. A Eureka moment. In the new light of discovery, endocrinologists were consulted, thankfully postponing the PET/CT scan. Throughout the medical callisthenics, I was reluctant to do the RTPCR on account of the associated stigma, and kept postponing it. However, the COVID-19 rapid antibody test was done. Again, fortunately negative for both IgM and IgG antibodies, suggesting neither current nor past COVID-19 infection.
A steroid course for Thyroiditis was started and it gave me some relief as the fever began to subside. Experience suggested all these could also commonly happen in COVID-19.
But the debate on suspected COVID-19 never stopped. Both scenarios were discussed. If I tested positive, in the most ideal scenario, then all of us had been exposed, had presumably been positive while remaining asymptomatic, and the infection had entered and exited everyone. So, the other seven would have escaped, considering the long duration of my symptoms. If negative, that was also fine, but the sword of Damocles still hung over us with the possibility of COVID-19 in the future. Also, the situation didn’t help much — the escalating COVID-19 cases in Mumbai, my clinic as well as residence being in Red-Zones, my continuing medical practice, standard precautions notwithstanding.
I was left with no option but to succumb to pressure and submit myself for the swab test. A ‘home visit’ was preferred. Discussions continued on the ramifications of the test results returning positive.
The home-visit technician came equipped with used hand-gloves, mask, disposable paper apron (worth ₹20), in her backpack, all of which were supposedly reused several times, and head-shield in hand. This was all in the name of a PPE kit for which labs charge ₹600/- extra.
The swab was put in my nose and I felt such terrible pain. The kind of pain that I do not remember, definitely not in recent times. Once the physical pain settled, the psychological pain began. What if the test results came out positive?
Though I have no co-morbidities, my age is itself considered ‘high-risk’. The children started discussing all the possible courses of action — and that included a list of preferences among among hospitals and physicians, ambulance, oxygen-support, ICU, ventilator.
That night of waiting was terrible. My wife started listing assets, liabilities, credit-card numbers, passwords and telling me to show everything to the children, all in the run-up to the ‘winding-up’ mechanism just in case I didn’t return from the hospital. At the back of my mind, I felt reassured that I would get a decent cremation with my close family in attendance.
The next morning, my wife drove me to the clinic, where we anticipated receiving the test results. I don’t drive, and she has been my chaffeur (or is it chauffeuse?) during the lockdown. While returning, we stopped by a bakery and bought cake for the celebration, come-what-may — COVID-19 positive or negative. As we awaited the report, the table was laid and decorated with cake, with confused faces all round.
The ‘report’ came to my younger daughter, the microbiologist. It was negative. Though the scenario of celebrating COVID-19 positivity did not pan out, here was still a cause for celebration! The negative report was a major solace for me as I had already lived and died in the meantime. At one point, I had even dreamt that I had an array of medicines following different protocols — Ivermectin, Azithromycin Tablets, Remdesivir and steroid injections included — and I had reached the so-called Cytokine storm and got a Tocilizumab shot, both made available to me despite scarcity, but finally reached a ventilator. I was just short of writing my own obituary when I woke up!
I am much better now and on steroids under the care of endocrinologist Dr. Shashank Joshi with the final diagnosis of Acute Painful Thyroiditis. Born again, and doing my bit to better the course of the COVID-19 pandemic, especially in the area of preventing stigma and discrimination.
(Through Foundation of The Billion Press)
