Nineteen-year-old Julia had off and on low-grade fevers for about a week, but no other symptoms. Then came the terrible cough. Two days later, the New Port Richey teen’s health drastically declined.
“I went to go to bed on a Tuesday night and my mom (Jennifer) came into my room and she noticed that I looked very, very ill,” says Julia. “Then she looked at my fingernails and toenails and they were bright purple.”
But strangely enough, Julia wasn’t having trouble breathing, and she still had her taste and smell, which are all symptoms of COVID-19. Earlier that morning, Julia went to the doctor where she was tested for SARS-CoV-2, the virus that causes COVID-19, but those results were still pending. Given Julia’s condition, Jennifer immediately took her to a nearby emergency center.
“I remember being met outside of the hospital and getting wheeled in on a wheelchair,” Julia says. “Then I remember the nurse taking my vitals and calling for a bed, because my oxygen was at 50 percent.”
She was positive for COVID-19. She is also diabetic, making her a high-risk patient. Julia was put on a ventilator and after three days, things were looking bleak.
“They said that COVID really seems to take a toll on a diabetic,” Jennifer says. “I do believe in my heart that they did everything they could and that’s how they presented it to me, but they were out of options.”
Doctors wanted to put her on the most aggressive form of life support called extracorporeal membrane oxygenation, or ECMO. It is a heart-lung bypass machine for people in life-threatening situations like Julia’s, but there were no beds available.
“The doctor said the only way a bed becomes available is if someone gets better, or they don’t,” Jennifer says. “So that was mind blowing to me that this was really happening. This is my 19-year-old daughter.”
Then there was a breakthrough. Jennifer’s sister, who works in health care, had a colleague suggest transferring Julia to a pediatric hospital to receive the expert care she needed. Johns Hopkins All Children’s Hospital treats patients up to 21 years old. Her health care team immediately jumped on the suggestion, and within hours, Julia was flown via the LifeLine helicopter to the pediatric intensive care unit (PICU) at Johns Hopkins All Children’s.
“She was very sick,” says John Kotula, M.D., one of her main critical care physicians. “Anytime we get a consult for ECMO in COVID-19 cases, that means the patient is as maxed out as they can be on a ventilator. Luckily, we were able to keep her off of ECMO and a lot of that contributed to the great teamwork in the PICU including very strong nursing, excellent respiratory therapists and a great group of physicians and everyone else — from our pharmacists to nutritionists.”
When a patient is infected with an illness such as COVID-19, pneumonia or any inflammation of the lungs, ventilators can be lifesaving.
“Those infections affect the amount of oxygen that’s able to get into the lungs and carbon dioxide, the bad gas, that’s able to get out. So, a ventilator can help keep the lungs open, allowing better gas exchange and oxygenation,” Kotula says.
The knowledge of the team in ventilator function is something Jennifer recalls and says made a huge difference in care.
“There is a mode on the ventilator that they said not a lot of doctors know how to monitor, but Johns Hopkins All Children’s did, so that was one of the changes they made on the first day.”
Jennifer got COVID-19, too, making it an even more difficult situation while she had to quarantine at home. But her sister was able to stand in for her and provide updates on Julia’s progress.
Julia received the standard of care for many COVID-19 patients including steroids to help bring down inflammation, Remdesivir (an anti-viral medication) and anti-coagulants (to prevent blood clots). She also had to be on antibiotics due to a secondary bacterial infection she developed. Due to her diabetes, she also needed additional medications, including insulin.
As each day passed, Julia’s oxygen pressure was lowered, and the sedatives needed to keep her comfortable while intubated were eased up. By the time Jennifer’s quarantine was up, Julia had improved immensely and was awake.
“That was pretty amazing, to see her eyes open, and she started to respond to questions with blinks because she was still very weak,” Jennifer says. “We went downhill, then we went right uphill so it was pretty miraculous.”
After a few weeks of two hospitals and a bleak prognosis to breathing on her own, Julia was finally able to go home.
“Seeing Julia talking to us and awake and finally going home is one of the happiest times for us in the PICU. It is a victory and keeps us coming back to work every day,” Kotula says.
The Challenging and Grateful Road Ahead
Earlier in 2021, Julia was on a journey to improve her health and the severity of her type 2 diabetes with a personal trainer and dedication to fitness. She made great strides toward her goals, including eliminating the need for insulin. Getting COVID-19 caused a major setback, which has been hard on Julia.
“Mentally, it took a toll on me, I felt like I should be better than how I was doing at the gym after COVID, but I know I went through a lot, and it’s going to take time,” Julia says.
Julia is also now vaccinated, which makes her and her family feel safer with an added layer of protection. She looks forward to being able to celebrate another holiday season, and this time, with family.
“We’re celebrating with my Nonna and Poppi for the first time since the pandemic started and I’m really excited to spend time with them. I’m grateful for a second chance,” Julia says.