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Jim Kauffman: It Takes a Village

Jim Kauffman, 62, resides in a Mount Washington neighborhood, but he has a village of his very own. He lives there with his wife, Wendy, 55, and their two Great Danes, Diesel and Lexie. Many others — family members, friends, co-workers, neighbors, fellow musicians — make up the population of Jim’s personal village, and although they don’t all know each other, they all know Jim and are linked by their great love and affection for him. He’s an easy guy to like — gregarious, energetic, witty and warm.

When Jim became ill in March with COVID-19, the villagers circled the wagons around him, and around Wendy, too. They became an army, fighting for a brother who was fighting for his life, and their love and support lifted and embraced the Kauffmans throughout a long, agonizing ordeal. Coupled with brilliant, painstakingly meticulous care provided by St. Clair Hospital’s health care professionals in the Emergency Room (ER), Intensive Care Unit (ICU), and COVID-19 Unit, the effort to save Jim’s life took on grand proportions. It took a village. And Jim survived COVID-19.

It started with a birthday party in early March, an ordinary family event to honor the 80th birthday of Wendy’s mother, Gail. Family members came from out of town to celebrate and everyone had a good time. A week later, Jim, who works for PNC Bank, began feeling ill. “I felt like I was getting the flu but it got really bad, quickly. I developed a fever, loss of appetite, shortness of breath and exhaustion. My thinking became fuzzy. I got out of breath just climbing the stairs. My fever spiked to 103 for several days. We called our primary care physician (PCP) and spoke to his nurse who said we were doing everything right. My fever started coming down, to 101, but my breathing and fatigue were worsening. My PCP saw me via telemedicine, but I don’t think he realized how drained and exhausted I was. I was just so sick.”

The COVID-19 pandemic was still in the beginning stages in the U.S. at that point. There was little information about it, and the social distancing restrictions had not yet been put into place. A few days after Jim became ill, Wendy developed symptoms: a dry cough, aches and pain, loss of taste and smell and a slight fever. She was fortunate — her symptoms resolved within a few days. But Jim was getting worse. Wendy was concerned about his breathing: “Jim has asthma, but he had never been short of breath like this. I tried to purchase a pulse oximeter on the Internet, but they were sold out. Jim’s sister brought us one and when we checked his level, it was 62 percent. We knew we had to go to the ER.”

Wendy’s mother Gail lives in Mt. Lebanon and encouraged Jim and Wendy to go to St. Clair. She called the Hospital’s Nurse Triage Hotline for COVID-19 and was told Jim needed to come to the ER, right away. Jim recalls watching Wendy pack a bag for him. “That was the last time I saw her, until 19 days later.”

A pulse oximeter measures oxygen saturation — the level of oxygen in the bloodstream. A normal reading is 95–100 percent. Jim’s 62 percent was dangerously low, a condition known as hypoxia. Hypoxia can cause damage to the body’s organs, including the brain. Upon arrival in the ER, Jim was placed on oxygen immediately. Chest x-rays revealed that he had severe pneumonia. His condition was so grave that he was sedated, intubated and rushed to the ICU.

Gregory J. Fino, M.D. is the Chief of Critical Care Medicine at St. Clair. Dr. Fino guided Jim’s care, from those first critical moments in the ER through his entire hospitalization. “Jim was extremely sick at admission, with a very abnormal chest x-ray, and he got much sicker. He was placed on mechanical ventilation right away, on high amounts of oxygen. The ventilator delivers oxygen directly to the lungs by way of a plastic tube called an endotracheal tube — when we say we intubate a patient, that’s what we are referring to. The tube is connected to the ventilator, which we set to deliver a specific mix of air and oxygen, at a specific rate per minute, under pressure, to force open the tiny airways in the lungs and oxygenate the patient.”

While Jim was in the ICU, Wendy was at home, isolated and scared, facing two weeks of quarantine with only her dogs for company. She was able to take time off from her position as a business analyst for a health insurance company, with strong support from her employer. “Help began to come from everywhere,” she recalls. “Due to COVID, there wasn’t much that people could do for me, but they gave me tremendous love and support. People reached out to me — my family, friends and employer. The information from the Hospital kept me going and I kept everyone up to date on social media. The response was unbelievable.”

To ventilate him effectively, Jim was heavily sedated and temporarily paralyzed with medications. The purpose of this was to keep him from “fighting” the ventilator. “Sedation allows the ventilator to do its job. Otherwise, the patient feels like they can’t breathe and they struggle,” Dr. Fino says. With the patient still and sedated, the ICU doctors, nurses, and respiratory therapists are better able to monitor his status and treat him. With state-of-the-art technology, they constantly track his vital signs, blood gases, fluid and electrolyte balance and the functioning of the heart, kidneys and liver. They administer medications: antibiotics, vasopressors, steroids — and they watch closely to assess the effectiveness of every intervention. These things must be constantly adjusted and tweaked for a patient as sick and unstable as Jim was. There were complications: Jim’s blood pressure skyrocketed and his blood sugar levels were erratic.

For days, the ICU team gave Jim aggressive ventilator support, through two modalities: 1) an approach to ventilation known as APRV — airway pressure release ventilation, a form of continuous positive airway pressure with two levels that cycles intermittently to release some of the pressure on the lungs; and 2) proning — a strategy that positions the patient on his stomach, because that allows for improved expansion of the lungs. Proning worked: after 24 hours of prone positioning, Jim’s lung function finally began to improve. In addition to the ventilator management, the ICU team also administered corticosteroids to Jim.

Eventually, the combination of APRV, proning and steroids made the critical difference, Dr. Fino says. “Those things really turned him around, finally. He spent 13 days on a ventilator and that is a long time. His asthma was a co-morbid factor for him. We were able to extubate Jim on April 7.”

Jim began having physical therapy to restore his muscle strength and learn to use a cane and walker. He continued to require supplemental oxygen, delivered by a nasal cannula. He had no memory of the ventilator; he needed the nurses to tell him where he was and why he was there. He had vivid dreams that seemed real to him — a common occurrence in the aftermath of a critical illness and medically-induced coma. Gradually, the amount of oxygen was decreased until he had been weaned back to room air. His oxygen saturation normalized and his chest x-ray cleared. He spent another few days in the Hospital, gaining strength and beginning to eat solid food. Although Wendy was still unable to visit, Jim called her. He continued to improve, and his spirits rose as his strength slowly returned. It was finally time to go home.

Jim looks back on his COVID-19 experience with many emotions, but mostly with gratitude. “This was my first long hospitalization and I had the finest care possible from the most amazing people — the doctors, nurses, therapists, aides and housekeepers,” he says. “At St. Clair, everyone is kind. When you can’t do things for yourself, you depend on others and that staff never let me lose my dignity. I wish I could remember every single name: Hannah, Clare, Bob, Matt and especially Rachel, the night nurse who was so quiet and effective, like an angel caring for me. Even the people who brought the (meal) trays were wonderful.”

“I don’t think the public realizes how much health care professionals care. We take them for granted and assume they’ll be there when we need them. They care about you personally and treat you accordingly. My experience at St. Clair was entirely positive.”

“Wendy and I are blessed to have family and friends. I have a village around me and Wendy is the queen. Everyone rose to the occasion and their support was inspirational. I know I have a long recovery ahead, but I am a little better each day. I still get out of breath on the stairs but my pulse ox is 95 percent. Not everyone with COVID-19 is as lucky as me. My advice to people is to stay home and stop fighting. If you need care, don’t procrastinate. Pay attention to early symptoms. Listen to the doctors and trust your instincts.”

Jim’s village continues to rally around him as he recovers. He and Wendy are grateful for the support and care they received from family, friends and a team of dedicated and expert caregivers at St. Clair. Sometimes, it does “take a village,” a phrase that usually refers to raising children but has a broader meaning. It’s really about needing each other, and about how the help and involvement of many is sometimes needed to reach a goal. Jim may have been in isolation as he struggled to survive, but he was never alone.

 

 

GREGORY J. FINO, M.D.

Dr. Fino specializes in pulmonary diseases and critical care medicine. He earned his medical degree at the University of Pittsburgh School of Medicine, where he also completed a residency and fellowship. Dr. Fino is board-certified by the American Board of Internal Medicine, including pulmonary disease. He practices with St. Clair Medical Services.

To contact Dr. Fino, please call 412.942.2025.