A highly experienced nurse knew to remain calm and turn her healing power inward as she fought COVID-19 in patient isolation for six long days in a hospital.
“You feel like you’re suffocating, and you can’t take deep breaths of air,” she says. “That gives you a panicky feeling sometimes. When I was on the oxygen, I felt a lot better. I’m sure [other patients] are feeling the same way — you panic because you can’t take in enough air. You get headaches and you feel fatigued.”
Kay Ball, PhD, RN, CNOR, CMLSO, FAAN, has decades of nursing experience and has been a professor of nursing at Otterbein University in Ohio since 2010. She also is a perioperative nurse educator and consultant, well-known for her research on the hazards of surgical smoke in the operating room. Ball described her hospitalization and recovery from the pandemic coronavirus in the following interview, which has been edited for length and clarity.
HIC: First, how are you feeling now?
Ball: I think I have totally recovered. It is something I wouldn’t wish on anybody. At the beginning of April, I started getting nauseated. I didn’t want to eat, had headaches, and was really tired. I had abdominal pain in the lower right quadrant, but I didn’t want to take up a COVID bed. I started thinking, do I have appendicitis? Finally, my family practice doctor told me that I should probably go to the hospital, and that was reconfirmed by a good [physician] friend of ours. There were three hospitals [in the Columbus, OH, area], and I took the smallest one because I happen to know people there. I went to the emergency room and they did a COVID-19 test to see if I had it. That hadn’t even crossed my mind. They gave me a CAT (computerized axial tomography) scan and the right abdomen showed nothing. The doctor came back and told me, “I am almost positive you have COVID-19” — although they had not gotten the test results back. He said, “Look at this,” and turned the computer around and showed me my chest X-ray, saying, “You have viral pneumonia, and it’s probably COVID.”
HIC: As you explain, you were sent home under precautions and advised to take zinc and vitamin C to boost your immune system. You were told to come back to the hospital if you started to struggle with breathing.
Ball: I had not thought about my breathing, but I was breathing very shallowly and if I took a deep breath, I would cough. I went home and sent an email to my “Ya Ya” sisters, four nurse friends, one of whom lives right in this area. I said I needed a pulse oximeter. My friend called around and found the only one available and brought it over and put it on the front porch of the house. I didn’t even see her. I didn’t sleep in my own bedroom that night because I didn’t want to expose my husband. I didn’t know then that he was going to test positive, too.
All night long, I did my pulse oximeter readings, which should be 95 to 100 in a healthy person. Mine were low- to mid-80s. I had a fever of 100.3°F, which is not really that high of a temperature, but it just came up. In the morning, we decided I needed to go back to the hospital. They put me on oxygen right away because I had such a low oximeter reading.
HIC: Your test came back positive for COVID-19?
Ball: Yes, and I was put in isolation. When you are sick, you are isolated, when you are healthy, you are quarantined. I was isolated in a room on a COVID floor they had set up. The nurses would totally gown up and use all the PPE (personal protective equipment) and take it off at the door before they went out. They didn’t come in very often, about three times a day. The doctor would come in about once a day. But we have to protect our PPE. We only have so much, and they can’t keep going in and out, because every time they go in they have to change to a new gown and gloves. That’s hard, and it’s expensive.
HIC: How did your treatment proceed?
Ball: I was having a pretty rough day and they started me on hydroxychloroquine. The doctor told me to lay prone — on my belly — five times a day for about 20 minutes each time. That allows the alveoli — the air sacs in your lungs — to open up in the lower part of your lungs. They have found that the prone position works for acute respiratory distress and patients can breathe better. When I flipped back over, I was able to take deep breaths a lot easier. Healthcare research has shown that the prone position helps people who are struggling with breathing. It was a chore because I had all these monitors on my chest — they were monitoring my heart because I was on hydroxychloroquine. I had heard they were using it, and that there were some side effects, but they took care of it by monitoring my heart. I knew it caused arrhythmia, and as a nurse I was feeling my heart to see if I had any [signs]. Being a nurse, you’ve got to nurse yourself. They also gave me a spirometer that you use to take deep breaths and told me to do that several times a day, too.
Because I was in isolation, they would put my food tray on a shelf right by the door. So, if I wanted to eat, I had to go get the tray myself. And that was good because it made me get out of bed, although I didn’t feel very good at all. So, I was in bed a lot and isolated. I watched TV and slept a lot because I was so tired.
HIC: You were on oxygen, but you did not have to be intubated and put on a ventilator?
Ball: Yes, and when you are just on oxygen how you recover is going to depend on how you are doing. You have to get up every once in a while. I had an O₂ cannula and it felt so much better when I was on oxygen — I could take a deep breath. Because every time you take a deep breath with COVID, you kind of cough. One of the things they say is to take a deep breath in the morning and if you have to cough something might be going wrong. Those were some of the tell-tale signs that I was having. Some of the nurses came in and said, “Dr. Ball,” because I have my PhD. They knew I taught nursing at a university, but they were so good because they would still explain to me everything they were doing. Every night I got a shot in my belly of [enoxaparin sodium] to prevent blood clots. That can be a big problem.
HIC: You mentioned you had feelings of your own mortality at some of the lowest points.
Ball: A lot of things go through your mind when you think of your own life. When is your time going to be and all of that. I had just started a study — a survey of nurses on the effects of surgical smoke. I was having thoughts like, “I need to call my statistician in Texas and tell him my sign-in and my pass code,” because I wanted somebody to be able to access this information. I was blessed. I survived, and I didn’t have to be intubated. I think it was because so many people were praying for me. The Good Lord’s arms were surrounding me, and I could feel that. I started feeling toward the end of my hospitalization, “I am going to come through this.” I knew I was getting better because I started to have an appetite. They brought me some roasted pork and mashed potatoes with warm gravy. That tasted so good — I was getting my appetite back. I didn’t eat everything — but the ice cream and sherbet always tasted good.
HIC: How did it feel to be discharged?
Ball: Just going through that door to get out — my husband is in the van, [and] of course as soon as I got in the car, I started crying. I was pretty emotional after being in isolation that long. The thing I would say to healthcare workers is to try to be as healthy as you can be, so your own immune system will fight this ravaging virus.
HIC: Your husband tested positive as well, but remained asymptomatic?
Ball: Yes, and we recently got antibody testing and we were both positive on that, so we are making the antibodies. So many people have asked me, “Well, how did you get it?” My husband and I were staying at home, and we when we went to the store we had N95 respirators and gloves on. We were doing everything, but I am a face toucher. I tell people don’t touch your face, but you put hand underneath your chin leaning on a table. It can come in through your nose or mouth, or maybe I just scratched my face — it can come through the mucosa around the eyes. So, my bottom-line now is do not touch your face — make sure you wash your hands. The other thing I am experiencing now, and you probably are too: People go out to grocery stores and they don’t even wear a mask. The mask is not to protect you — it is to protect everyone around you. I don’t think I can get it a second time, but maybe I can, I don’t know. If you think that masks don’t prevent the spread of germs, when you come in for surgery we will let your anesthesiologist, surgeon, and nurses know. We are glad not to wear a mask around your incision. Think of it that way. If I was going in for surgery, would I tell my surgical team not to wear masks? We are not protecting ourselves, we are protecting you. Think about that when you are out in public, you are protecting everybody around you.
HIC: Where are you at on the research paper you mentioned?
Ball: I am trying to write the article for the AORN Journal based on the nurse responses — 1,300 nurses responded to my survey in a one-month period. It shows that we have so many nurses now with respiratory problems from breathing in surgical smoke when we cut and coagulate tissue. This happened in April in the middle of COVID, and the nurse could write comments at the end of survey. Many commented on how COVID has pushed their hospitals to have a smoke-free surgical department. Hospitals are mandating smoke evacuation in some of their places. Some of the surgeons who were so resistant are saying, “We better not be breathing this stuff in if we are operating on a COVID patient — we don’t know how it is transmitted.” So that has been a silver lining.