The man in the video on Karma Sammy’s smartphone plays guitar in a crisply pressed suit. He sings along to the clapping of those around him. His eyes light up the room.
Weeks later, her husband, 67-year-old Ken Sammy, was dressed in a washed-out hospital gown, paralyzed and unable to speak. His mouth, nose, and throat were riddled with sores from intubations, ventilators, oxygen masks, and feeding tubes. His body was exhausted from its struggle with COVID-19.
He could communicate only with his eyes and he used them, fiercely, to tell nurse Nikky Oldham to back off. She got the message. Even behind gloves, gown, mask, and face shield, she could tell he was afraid.
“He couldn’t move, breathe, talk,” said Oldham, “He was trapped inside his body and couldn’t communicate with his hands, but any time you came toward his face meant pain. It was hard to reassure him; I don’t think he trusted anybody.”
The Sunday Oregonian on May 9 carries a special section on Health Care Heroes in the age of COVID-19. Read all the stories and first-person accounts at oregonlive.com/health.
Later, Ken would say he dreamed that weapon-wielding extraterrestrials in space suits were attacking him. He desperately tried to ward them off. He scratched and pulled in his sleep, often dislodging his IVs or feeding tube. At times, he had to be restrained.
Though Ken was only dimly aware of it, he was at the center of a titanic, months-long struggle between the novel coronavirus and the medical team dedicated to saving him. His case is a grim illustration of the extreme efforts sometimes needed to defeat COVID-19. More than that, it is a story of life and near-death, of epic suffering, of long-lingering harm, and of lasting love.
Fever and muscle aches
Ken and Karma Sammy met as teenagers at a church in Trinidad, the larger of two islands of the Caribbean nation of Trinidad and Tobago. Ken played guitar; Karma sang in the choir. Soon, they were inseparable. They immigrated to the United States, became citizens, and raised four children in Portland. Their youngest daughter, Rachael Schulz, lives just down the street with her husband, Danny, and their four young girls. The Sammys remain active church members.
Ken has a devotion to grand Christmas displays. On Jan. 1 he spent several hours dismantling his 2020 installation in the winter rain. He came down with a cough that evening. Karma chalked it up to a cold, brought on by a long day in poor weather.
By the next day, he had fever and muscle aches. Rachael suggested he go to urgent care; he insisted he was fine. The tug-of-war continued for the next few days, as his condition worsened. Eventually, he agreed to a virtual visit with his primary care provider, who sent him for a COVID-19 test.
The nurse checking his vital signs was so surprised by his low blood-oxygen level that she replaced the batteries to ensure the unit was working. Then she sent him to the emergency room.
They arrived at Providence Milwaukie hospital on Jan. 6, and Ken struggled to communicate but was upright and walking. Dr. Reed Epstein, the emergency physician, recognized the pattern: A patient appears mostly fine, but the pulse oximeter reads in the 60s or 70s. “Right when we saw that oxygen saturation,” said Epstein, “we knew he had to be separated and moved to an isolation room.”
All three family members were tested for SARS-Cov-2. Only Ken’s came back positive. Rachael and Karma had no choice but to leave. Ken was becoming incoherent, and the couple said their goodbyes through looks not words. Ken’s eyes pleaded with Karma to stay. Karma’s, fearful, said how sorry she was to go.
Post-holiday surge
Six hours later, Ken lay in an ambulance headed for Portland Providence Medical Center’s intensive care unit, 10 miles away. Much of the country was grappling with a post-holiday surge that was overwhelming hospitals and filling ICU beds to capacity.
Providence Health and Services, a statewide not-for-profit network of hospitals and care centers, had prepared for COVID-19 by consolidating coronavirus care at its two larger Portland hospitals. That allowed it to create specialized COVID-care teams and to consolidate personal protective equipment.
Even so, the pandemic battered the hospital’s 3,500 caregivers.
For months, some caregivers recalled, PPE guidelines seemed to change almost daily, fueling fears of catching the virus or bringing it home to loved ones. There were more patients, with more complex needs, but less time to spare because of the constant need to don, doff, sanitize, and dispose of gear. Caregivers reported feeling physically and mentally exhausted. But they kept showing up for work.
At the height of the hospital’s COVID-19 surge in November, there were 93 inpatients with COVID-19, nearly 20% of available beds.
Ken was one of the tougher patients.
Intensive care can cost upwards of $10,000 per patient, per day, which only begins to describe the strain COVID-19 imposed on healthcare systems.
In the ICU, Ken’s body wrestled with inflammation, delirium, and kidney failure. On Jan. 9, he was intubated and placed on a ventilator. Isolation protocols banned family in the room. Karma relied on critical-care nurse Lee Bulwinkle to keep her updated on Ken’s status. Bulwinkle would hold a phone up to Ken’s ear. Sometimes his grandchildren said hello and sometimes Karma prayed or sang to him.
“With COVID, that’s a huge part of my job,” said Bulwinkle, “We need to take care of the family because we can’t take people in to see the patients themselves.”
For 13 days, it was touch and go. A rotating corps of 20 nurses, doctors, pharmacists, and respiratory therapists fought around the clock to give Ken’s body time to fight the virus.
They administered medication to counteract the virus and help him tolerate the ventilator, and they repositioned him in his bed to ease his breathing. Kept mostly prone, Ken needed regular head turns every two hours. It took six people to flip him.
Ken’s lungs were the big danger. COVID-19 causes the lungs to harden. Caregivers must balance between providing enough oxygen and staying within the lungs’ capacity to receive it. Blowing too much air into stiff lungs risks damaging healthy tissue.
Bacterial or fungal infections were another risk. They watched for temperature spikes or other signs that he might need medication.
Blood clots were known killers. They constantly monitored his blood pressure and looked for signs of swollen limbs.
Eventually, Ken began to improve. The critical care unit follows a holistic approach to treatment shown to improve outcomes. They turned off Ken’s sedation, woke him up, tested his breathing off the ventilator, and got him moving.
Once stabilized, he was transferred to the medical floor, where the hospital allowed patients one visitor per day. Everyone agreed that person should be Karma.
Their reunion was joyous, but brief.
“It was a very busy night, and I got a call from the rapid response nurse that they were worried,” recalled pulmonologist Dr. David Hotchkin. “When I went to go meet Ken, he looked just terrible.”
Ken was wheeled back into critical care. Karma asked to stay at his side. Hotchkin agreed to make an exception.
“It was so refreshing to have some normalcy, despite everything that was not normal,” said Hotchkin, reflecting on how often loved ones would stay with family pre-pandemic, “It’s so much easier to see someone as a person. I got to meet his wife. I got to see who he was.”
One of COVID-19′s cruel habits is to circle back on recovering patients and take them down again. Ken’s relapse was swift and serious. Intubated a second time and back on the ventilator, he began bleeding internally. Ken lost so much blood he required a transfusion. Then, one day, for no obvious reason, the bleeding stopped.
ICU doctors and nurses told Karma what it all meant and what the treatment options were.
“Instead of feeling fear in that moment, I felt a sudden strength,” said Karma, “I told them, ‘I want to do anything we can possibly do to help him make it. If he doesn’t make it, at least I’d know we tried, and you had done your best.’”
By the next day, Jan. 23, Ken’s organs were shutting down. Doctors told Karma it was time to contact family. Watching Ken’s shallow breathing, the doctors checking on his brain activity every 15 minutes, Karma turned to her faith. She called her pastors to pray, holding the phone to Ken’s ear.
‘The beginning of a miracle’
The next day, as she rubbed Ken’s ice-cold feet, she felt them warm to her touch. She moved to his hands; as she heated them up, his blood pressure went down. These small moments propelled her.
“I knew that was the beginning of a miracle,” she recalled.
About 30 percent of the patients put on ventilators die. By Jan. 27, it appeared Ken would be a survivor. Doctors eased back on his sedation and, the next morning, took him off the ventilator. He opened his eyes.
Various caregivers attributed his recovery to luck, genetics, Ken’s resiliency, or Karma’s support. Many said that’s just how COVID-19 worked sometimes. Some said, “miracle.”
After 21 total days in critical care, Ken returned to the COVID-dedicated medical floor. He was out of the ICU but still deep in the woods. The virus had wreaked havoc on his body. He was not responding or moving. His eyes did not track motion in the room.
“Nobody knew what to expect,” physical therapist Justin Philips said. “We didn’t know if he had a hypoxic brain injury, was in a hospital-induced delirium. ... He could not speak. He was not even making attempts to speak.”
To stimulate Ken’s senses, Philips introduced passive range-of-motion exercises to Karma, who took the reins without hesitation.
She made note of small daily changes. The first time Ken wiggled his toes, the time he whispered as she shaved his face, the call with his niece in Trinidad, when he appeared to look for her in the room. She watched his eyes beginning to track people.
Karma showed nurse Nikky Oldham the video of Ken singing and playing guitar. Oldham could hardly reconcile her patient with the polished man on the screen, but she recognized the support Karma provided.
“She was amazing. It was just an incredible image of love that they shared,” said Oldham. “It was hard not to fall in love with them.”
Cari Piercy, a respiratory therapist, walked into the room to do a routine nebulizer treatment. “Karma just started talking to me,” she recalled. “She started talking about life. She just has this glow, this light, when she talks about him, and this never-ending love.”
A certified nursing assistant for 27 years, Karma had the medical know-how to ask the right questions. She helped with turning and hygiene and lifting. She rarely left Ken’s side.
Ken has no solid memories from Jan. 1 through early February. Back on the medical ward, though, “I think I became really aware,” he said. “When I became conscious, I realized that I had no energy to speak, but I kept trying and trying and trying. I could feel the pain and pressure on my vocal cords.”
After multiple or prolonged intubations, many patients take time to regain their voices. But as days went on and Ken’s voice did not return, speech-language pathologist Myranda Sena became concerned. She requested a bedside evaluation that could determine if trauma or paralysis explained things.
Ken’s vocal cords proved to be functional. Perhaps buoyed by the good news, Ken saw his voice begin a slow return. As he gained strength, his communication evolved from eyes to gestures to whispers to words. The process took several weeks.
Hospitalist Dr. Laura Kuipers could see Ken’s personality emerge, “I could see he had a sort of dry humor; the eye-rolling or the eye brow up, almost teasing me. He had a way of communicating even when not speaking.”
“Slowly, he started to say a word or two,” nurse Oldham recalled. “One time, he whispered to me something to the effect of ‘She talks too much.’” Karma giggled at that.
Ken and Karma requested Oldham whenever she was working. “Nikky,” Ken recalled later. “Even on days when she wasn’t working in our section, she came to see me, and that felt so good.”
Patients recovering from serious COVID-19 infections would normally go to a skilled nursing facility for rehabilitation. Ken and Karma wanted to go straight home, though, and their care team agreed.
“They are a bit of an unusual family, just because of their closeness, their devotion to each other, their willingness to be available for one another,” said Erika Petersen, the licensed clinical social worker involved in discharge planning. “Everybody felt for their mental health that going home was the best choice.”
Before he could go home, Ken needed a hospital bed, a wheelchair, and supplies for the feeding tube that sustained him, while he regained the strength to swallow. Some equipment was covered by insurance, some not. Margaret Grant, RN care manager, monitored their equipment and medical needs, discussed their goals, and ensured he was set for home visits from nurses and therapists.
Even after he left the hospital, Ken would need the support of a small medical village.
Discharge day
After a 59-day stay, Ken was ready to go. Oldham stopped by on his discharge day. “There are some who just touch my heart beyond words, and they become lifelong friends,” she said, “You develop a bond.”
Piercy, his respiratory therapist, also stopped by, “I had to run back to their room and give them air hugs,” she said.
“Ken was one of those people that everybody banded together around,” said Philips, the physical therapist, “Just celebrating his recovery together as someone you could think of as a good reminder of why we do this.”
At Portland Providence Medical Center, every time a COVID patient is discharged, “Here Comes the Sun” plays over the hospital sound system. On March 5, 2021, Ken and Karma left the hospital with George Harrison’s song and the cheers of the staff as background music.
At home, Rachael and Danny stopped by and the grandchildren made posters. Seeing the grandkids for the first time in months, Ken looked “like a child on Christmas morning,” Karma said.
As sunny as their return was, there were difficult days ahead.
“I have a form of PTSD; I get nervous,” said Ken, “I have to put on my oxygen. It still turns in my mind. I would see my wife in the other room start talking about something, and I’d just start hyperventilating.”
Ashley Witty, an occupational therapist with Providence Home Health, visits Ken twice per week. She said it is common to see PTSD, anxiety, and depression in patients recovering from COVID-19. Many have sudden episodes of rapid heart rates or an overwhelming feeling of respiratory difficulty.
Mental health support for so-called “long COVID” is spotty. Online grassroots efforts such as Body Politic or Survivor Corps aim to bring together COVID-19 “long-haulers” to network and share resources. Ken has a home health team that includes a mental health nurse and other therapists, who together are able to address the trauma of a hospital stay and managing expectations.
“Right now, instead of thinking about too far in the future, it becomes overwhelming,” said Deborah Folk, Providence Home Health RN, who works with the Sammys, “We have to focus on day by day. I reinforce: you have made progress, incredible progress. Every week, I see him stronger.”
“We live in a world of instant gratification, where even your groceries can be delivered in two hours,” said Witty, “The human body doesn’t get better in two hours or two days. The human body takes time, and with COVID, it takes even more time.”
“COVID took healthy people and made them chronically ill,” said Kuipers, the Providence hospitalist. “What we are seeing is mostly healthy people get super sick, and take a long time to recover.”
Ken has big goals, like finishing a bathroom renovation started before he got sick. For now, though, his therapists are working on smaller steps, such as bathing, fixing himself a snack, and getting in and out of a car.
“It’s difficult to know where I got this thing, but it’s here, and people should take it seriously,” Ken said.
Also on Ken’s to-do list is thanking his caregivers by returning to the hospital to play guitar and sing for them. He’s working to get his voice strong enough to sing, his body strong enough to play.
“I like to keep my word. When I say I am going to do something, to not do it… that’s just not in my DNA,” said Ken, “It will be my privilege to go back and share that with them.”
Lee Ann Moyer lives in Portland, Oregon with her husband and four children. She is a freelance writer and small business owner. Contact her at hello@gulchmedia.com.
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