Vital Times 2022 - 90

SPECIAL FEATURES
Experiencing Long Covid as
a Physician and a Patient
Zeest Khan, MD
T
he sound of the drape
pulling back, metal rings
on a metal rod, rustles a
memory. " So, " he says kindly, " I
hear you're an anesthesiologist. "
I look up at the physician who
has entered the preop bay where
I lie on a gurney. I smile under my
mask and reply, " Not today. "
I am, of course, an anesthesiologist. Even recently, I was
running a successful solo practice, had a hard-earned
reputation for clinical excellence, and held leadership
positions. I had a healthy marriage, healthy children, and
a healthy body. I visited my aging parents regularly and
figured out my optimal tax strategy. Nine years out of
fellowship, I was in my groove. In 2020, however, I fell
ill-likely from Covid-19-and I have yet to recover. I have
spent the past year in bed, in waiting rooms, in hospital
gowns. So, that day as I had an IV placed and met my
own anesthesiologist, I was not in my physician role; I was
a surgical patient with Long Covid. Given that millions of
Americans share my diagnosis, you may care for patients
like me. Here is what you should know.
Long Covid refers to a constellation of symptoms that
remain, often for years, after a confirmed or probable
SARS-CoV2 infection. It is popularly known as Long Haul
Covid and clinically known as Post-Acute Sequalae of
Covid (PASC). Long Covid has significant overlap with
an identified but under-researched condition called
Myalgic Encephalitis-Chronic Fatigue Syndrome (ME/
CFS). ME/CFS has known viral triggers, including other
SARS viruses. Symptoms include breathlessness;
reduced exercise tolerance; an impaired ability to
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recover from exertion, known as post-exertional malaise;
dysautonomia, often presenting as orthostatic intolerance
and tachycardia; hypercoagulability; tinnitus; cognitive
impairment; and profound, disabling fatigue.
I remember the day I admitted I was unwell. I had been
avoiding the truth, telling myself I was just tired like we
all were during the pandemic. I just needed a vacation. I
just needed some sleep. None of those theories held up,
however, when I found myself sitting on a patch of grass
at dusk, the hospital to my right, the parking lot to my
left. I was wearing my medical suit of armor: scrubs, a
fleece jacket, and leather clogs. As I slumped forward, I
tried to focus on the pattern on my compression socks,
a poorly drawn ECG. Just breathe, I told myself, just get
up. But I couldn't. I was 41 years old, a sub-specialized
physician, and the mother of two children. I held many
roles and wore many suits of armor. I was strong. But
at that moment I could not walk the remaining 10 yards
to my car. I eventually made it home and I withdrew my
work commitments. Over the subsequent months, instead
of improving with time and rest, I felt worse. I became
well known to my internist as well as many specialists.
Ultimately, I was diagnosed with ME/CFS, possibly
triggered by Covid-19.
Patients with Long Covid present with myriad symptoms
and workup is slow. There are no reliable prognostic
indicators and no reliable treatments. There are no
experts yet. Although research is underway for Long
Covid, we can extrapolate from what we currently
know about ME/CFS, a multiorgan system disease the
mechanism of which is only theorized. ME/CFS may be
an immune-mediated response to infection. It commonly
disrupts the autonomic nervous system and possibly
Vital Times 2022

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