Something about the patient’s chart caught Dr. Melissa Saad’s attention. He was on a list of patients waiting to be examined further and was 45 years old and complaining about shortness of breath. It was late Friday, March 6, in the emergency department at Danbury Hospital.
“He was slightly hypoxic [low oxygen level] which worried me a bit,” Saad says. “I assigned myself to him and jumped into his chart. I saw he had just traveled for work back and forth to California before he became sick.”
She learned he’d had a fever for days, even though the doctors he’d seen outside of the hospital had given him Tamiflu and two antibiotics. The assumption was he had pneumonia, but Saad didn’t think that was it. “A big red flag went off. I still remember looking at my partners that night and saying, ‘You know they’re swimming in it over there in Washington and California. Crap, I think he’s got it.’ ”
Seven days earlier, on Feb. 28, Chris Tillett flew home from the RSA Conference in San Francisco, the world’s largest cybersecurity gathering. By the time he got to the house in Wilton he shares with his wife, Elizabeth, and two 5-month-old twin boys, he was exhausted and beginning to lose his sense of taste. He was at the conference, which was attended by 40,000 people, with Exabeam, the cybersecurity company where he works. In addition to helping man a booth at the conference, he’d also been getting up at 5 a.m. to talk with clients on the East Coast. He chalked up his exhaustion and overall crummy feeling to the long workweek.
By Monday he had a fever and went to the doctor. In early February, Elizabeth had the flu and now Chris was tested for the flu as well. The test came back negative but the doctor told him they were going to treat him for presumptive flu anyhow.
Chris already suspected it was COVID-19. He’d had swine flu in the past and felt “this was no flu.” California saw its first coronavirus case in late January and the number of confirmed cases had been slowly rising ever since. Even so, medical staff in most of the U.S. were still only worried about the potential of coronavirus in patients who had traveled overseas, and were primarily concerned with those who had been to Asia.
He called his doctor’s office asking to be tested for coronavirus, but they didn’t even know how to get a test. Even his wife initially thought he just had “a man cold.” On Wednesday he was having difficulty breathing; a chest X-ray revealed pneumonia on one side. By Friday his breathing had grown far worse and the Tilletts went back to the doctor’s office where they learned Chris now had pneumonia in both lungs. Still, no one was taking Chris’ worries about the coronavirus seriously.
Elizabeth brought Chris home and then went to pick up his medications. By the time she got home he could barely sit up and had turned gray. Elizabeth is a nurse and had a pulse oximeter that she used to measure Chris’ oxygen. She knew the normal range for oxygen is 92 to 100 but Chris was at 89, and if he moved at all, even lifting an arm, it dropped to 79, “which is critical,” Elizabeth says. She immediately drove him to the hospital.
That Friday had already been a strange one at Danbury Hospital. Earlier in the week, a hospital employee who lived in Westchester, New York, tested positive for COVID-19. The employee spent time at both Danbury and Norwalk hospitals, which are owned by Nuvance Health. On Friday the health system announced that employees who came in contact with this employee had been sent home for 14 days.
The positive employee worked in isolated parts of both hospitals and the incident seemed under control, but still made a splash in the media. Earlier Friday evening, Gov. Ned Lamont held a press conference at Danbury City Hall. The tone was serious but cautiously optimistic. The governor’s official Twitter account tweeted a photo of the governor in Danbury with 19 other people in a cluster around him including the city’s mayor, Mark Boughton, Norwalk’s mayor, Harry Rilling, and other officials. In an earlier press conference, the governor assured residents, “We’re prepared, we’ve been preparing for this for a while ... probably it’s going to look like a bad flu season.”
The optimism was not without reason. Even though hospitals across Connecticut were bracing for the virus’ arrival by creating various triage stations, there was some thought that the impact of the virus would be minimal. The first New York case had only been reported the previous Sunday, and there were still only 33 confirmed cases in the Empire State. In Connecticut, 42 coronavirus tests had been given, and all had come back negative.
Hours after Lamont’s press conference in Danbury, Saad was treating Chris as a presumed coronavirus patient. He was placed inside a negative-pressure room and staff who went near him wore full protective gear. When Saad told him she thought he might have the coronavirus, he said, “I’ve been saying this for a week, doctor; you’re the first person that’s listened to me.”
Saad sent Elizabeth home to stay isolated and be with their children. She looked at Chris’ chest X-ray and lab results, and her worst fears seemed to be confirmed. “They were consistent with what we had heard so far about how coronavirus affects the body.” She notified pulmonologist Dr. Jose Mendez and called Dr. Paul Nee, an infectious disease specialist at the hospital. It was after midnight and Nee had just returned home but quickly headed back. Nee and Mendez agreed with Saad — it looked like it could be COVID-19.
“As I looked at the pictures of his wife and twin babies, I knew that I had to do everything in my power to get him home.”
By early March, the Centers for Disease Control and Prevention had given Connecticut test kits that enabled the state to run a little over 500 tests, and criteria for who qualified for the limited tests was strict. Samples for each test had to be delivered to the Connecticut Department of Public Health State Laboratory in Rocky Hill.
Chris’ test was delivered to Rocky Hill on Saturday. When the results hadn’t come in by around 8 p.m., Nee didn’t think they would come that night. The hospital was relatively calm. Chris had started getting oxygen the night before and was stable and seemed to be doing well. Nee called Elizabeth. He could hear the twins in the background and told her to get some rest. Knowing the coming days might be difficult, she took that advice and went to sleep.
Soon after the call, the calm over the hospital shattered. First the test came back positive and then Chris’ condition started getting worse.
Dr. Guillermo Ballarino, the pulmonologist in charge of Chris’ care overnight, saw that he needed more and more oxygen and “we expected that to get worse rapidly,” he says.
Staff members tried calling Elizabeth, as did Chris himself, but she was asleep. Elizabeth woke up at 4 a.m. Sunday with more than 25 missed calls from the hospital and Chris. She called her husband. He answered and told her he had the coronavirus, but he was so out of breath he could hardly talk.
As the early morning progressed and Chris’ condition worsened, Ballarino and others decided he needed to be intubated and placed on a ventilator.
Arriving at work that morning, Mary Kate Tannone, an ICU nurse, learned that the hospital had the state’s first coronavirus case and it wasn’t going well. She volunteered to help get the patient prepared for intubation. She entered his room nervously in full PPE, but Chris put her at ease. She introduced herself to him and explained what the hospital had planned and asked him if he understood. “He responded that he did, and then he thanked me for not being afraid to take care of him,” Tannone says. “In that moment, my heart broke for him and his family. As I looked at the pictures of his wife and twin babies, I knew that I had to do everything in my power to get him home.”
When they transferred Chris to his room in the ICU, Tannone got his permission to text his wife using his phone, as he was too exhausted for even this level of exertion. “I told her my name and the direct number to the ICU and told her she could call at any time for updates,” Tannone says.
The team was now preparing for the first intubation on the first confirmed COVID-19 case in the state. It was a scenario they had planned for long before Chris entered the hospital. They were ready, or as ready as they could be.
Intubation is a dangerous procedure for caregivers when it is done on any patient with an infectious disease, but now they were dealing with a new virus with unknown contagion levels, and being asked to put themselves at risk in a way many had never signed on for. Like soldiers preparing for battle, they donned their protective equipment. Nee, the infectious disease doctor, was on hand to make sure everything was put on correctly. He tried to remind the team they were ready. “We do this every day. We gown, we glove, we mask every day. It’s no different,” he told them.
Marcia Ney, a registered respiratory therapist who was part of the intubation team, says “since everybody else was so calm and everything seemed to be moving so smoothly” she wasn’t even worried. “It’s my job,” she says. “That’s what I’m there for.”
The intubation was a success and Chris, now in a medically induced coma, was on a respirator.
“You want to take care of the patient, but you’re also worried about yourself. But everybody in that ICU, everybody stood up, stepped forward,” Nee says. “They were going to take precautions but they put themselves aside and took care of the patient. In my life that’s going to be one of the greatest moments I’ve ever seen.”
Elizabeth had been informed that Chris was going to be intubated, and after the procedure Dr. Mendez, the pulmonologist from Friday who was now back on duty, called her to tell her it went well.
Elizabeth had a low-grade fever that day and, though she was never tested, believes she may have developed a milder case of the virus. But she was encouraged that Chris had been placed on a ventilator. “I was relieved his body was getting a break. I was relieved that his oxygen level was up,” she says.
That relief would be short lived.
Mendez was in charge of the ICU team caring for Chris that day. “I’ve never seen the ICU team in action with such great compassion,” he says. “Nobody complained about anything. Everybody was doing what they were supposed to be doing like a perfect machine, like we had done this for years, and this was patient one … ”
Mendez focused on the minute-by-minute and hour-by-hour aspect of Chris’ care, reminding himself, “Just do my job and make sure he stays alive for one day and then I’ll pass him on to John, who’s on the other end.”
Dr. John Chronakos took over the ICU team caring for Chris when Mendez’s shift ended. “I remember how calm and composed everyone was, but it was uncharted waters and there was a measure of uncertainty and a measure of fear,” he recalls. That night and week he reached out to colleagues in Milan over Twitter and WhatsApp. “They got back to me real quick and shared stories and ventilator and medication-management strategies.”
After Chris was confirmed positive, the state asked Elizabeth to help trace her husband’s movements. Because he had felt poorly as soon as he returned home, he had minimal contacts beyond those on his flight, and the Tilletts don’t believe anyone he came in contact with contracted the virus. The Tilletts are confident that Chris contracted the virus at the San Francisco conference because others in attendance came down with it, including people from Chris’ company on the trip.
On Monday, March 9, a second Connecticut resident tested positive for the disease, and the next day the state had its third known case. Despite increasing anxiety about the virus, life in Connecticut remained mostly unchanged. Businesses and schools remained open, including Western Connecticut State University, which has a campus less than a half-mile from Danbury Hospital and wouldn’t close until Friday. On March 16 movie theaters, restaurants, gyms and other higher-volume businesses were closed, but it wasn’t until March 23 that all but essential businesses closed.
“Everybody was doing what they were supposed to be doing like a perfect machine, like we had done this for years, and this was patient one.”
Meanwhile, inside Danbury Hospital on the week of March 9, Chris’ condition deteriorated. Elizabeth recalls that “after about two or three days, his lungs were doing worse, they were filled with fluid. He had that cytokine storm, so he had an over-immune reaction. That was when it really hit me. He was really sick when he went in and he’s sicker. He had acute respiratory distress syndrome, called ARDS, that in and of itself has a 50 percent mortality rate, and then add the fact that he had this unknown virus, so just statistically in my mind he had an even poorer diagnosis at that point.”
Elizabeth became convinced her husband would likely die. “I’m a rational, logical person, so I was like, OK, I have to mentally prepare myself that that could happen.”
Each day Chris’ body was turned to prevent sores, and staff constantly monitored his vital signs. “On a daily basis, the resident and attending physicians, nursing and respiratory staff involved in his care would meet and discuss his care,” Nee says. “Nursing would report on trends they may be noting or overnight events, respiratory monitors his lung status, how he is reacting on the ventilator. We all follow lab trends and make a plan for the day for the patient’s care. Many days there was not much to do other than support him and give his body time to heal. Other days if there might be a change like a fever, which we would need to evaluate with more testing. One of the most important things we monitored was how much oxygen was required.”
Nee and others interviewed for this story emphasized how large a team it was that worked on Chris and how important everyone was, from the doctors and nurses to those who cleaned the hospital.
The team also threw the kitchen sink at the virus. They gave Chris a combination of the malaria drug chloroquine and the HIV drug Kaletra and applied to Gilead Sciences for remdesivir, but Chris didn’t qualify. Elizabeth was in constant contact with Nee who took into account suggestions she made from her own research. Based on Elizabeth’s prompting, Nee considered giving him Vitamin C via IV. It’s an experimental treatment that may be effective in COVID-19 cases, but Chris’ lungs were so full of fluid that Nee and the hospital team thought it could be dangerous in his case.
Both the Tilletts and Nee say it’s unclear which, if any, of the treatments were effective.
“At the time you’re a little bit desperate. You want to feel like you’re doing something rather than nothing,” Nee says.
But hospital staff did more than treat the patient with medications and ventilator settings. Dawn Martin, chief nursing officer at Danbury and New Milford hospitals, says the ICU staff played music outside Chris’ room and arranged for Elizabeth to video call with him, so she could at least see her comatose husband. “Those personal connections are just as important as the technical skill that goes into the care,” Martin says. “He got very holistic care by a very strong and amazing team.”
Elizabeth adds, “Clinically they took care of Chris but they took care of me and the babies too.”
In the midst of what she calls the worst two weeks of her life, Elizabeth learned to take no news as good news. “He didn’t have very many days where he did better, but the doctors would say, ‘OK, he hasn’t gotten worse today.’ That would be a comfort for me,” she says.
Slowly he started requiring less and less oxygen each day. “As he required less we gave him less until he was able to breathe on his own,” Nee says.
On March 17, after 10 days of being on the ventilator, Chris was taken off of it. He says that coming off the ventilator was like waking up from an interminable, fevered dream. He thought those 10 days had all been one night. It felt like “one long, insane dream that you never wake up from,” he says. He was grateful to be able to breathe under his own power again, but his brain wasn’t working right. “I woke up thinking all kinds of paranoid and terrible things that were not true,” he says. His delusions included thinking his wife had taken the kids out of state away from him.
Elizabeth says that people kept asking her what his first words to her when he woke up were, “thinking it’s going to be this romantic story. His first words to me was he was mad at me for taking the children internationally without his consent,” Elizabeth says.
At the same time, she wasn’t done worrying he would relapse. “They warned me from results coming out of China and Italy that for some unknown reason people started to do better and were extubated and then within days were reintubated and were much, much sicker than even before,” she says. “So I was still holding my breath, for three or four days expecting this. But that never happened for him.”
“It takes a special ER doctor to be that confident to make a presumptive clinical diagnosis considering she’d never seen this disease. Honestly, I feel like we owe her our life.”
As Chris recovered mentally he worked with the physical therapy team at the hospital and learned how to walk and eat again. He says his physical therapist was so positive about even small gains that it inspired him.
“I had one fleeting moment of why did this have to happen to me and I was just complaining,” Chris says. “Then I said, you know what, what’s that going to do? I started saying a little gratitude prayer every morning, thankful for my health and the people that were caring for me. And every morning they gave me this little Flintstones chewable vitamin. That was my moment to go, you know what, I made it another day, I got my Flintstone.”
Chris initially thought he was still the only coronavirus patient in the hospital and didn’t yet understand the scope of the pandemic. On March 18, a day after Chris came off the ventilator, Lamont announced the state’s first coronavirus fatality had occurred at Danbury Hospital, an 88-year-old who lived at a nearby senior living facility. The number of confirmed cases in the state was 96, and Danbury Hospital, like others across Connecticut, was seeing waves of coronavirus patients come in.
“We started with an average daily census of 14 ICU patients and before we knew it we had more than 40,” says Martin, chief of the nursing staff.
Chronakos, one of the pulmonologists in charge of Chris’ care, adds, “I remember being in our COVID ICU that we created and having one patient and turning around and there was nine and I turned around again and there was 18.”
Chris left the hospital on Monday, March 23. It was earlier than normal for someone in his condition, but he wanted to free up the bed. By that time there were 415 confirmed coronavirus cases in the state and the numbers were still going up rapidly. At home, Chris was still wary of stairs and not fully himself mentally. Elizabeth hid the car keys and changed their important online account passwords. He started working from home in April and was able to hold and care for his children again. By early May he was 95 percent recovered.
The Tilletts credit the entire team at Danbury Hospital with Chris’ recovery. Elizabeth thinks that if Dr. Saad hadn’t taken the case seriously that first night the result could have been tragic. “It takes a special ER doctor to be that confident to make a presumptive clinical diagnosis considering she’d never seen this disease. Honestly, I feel like we owe her our life. We could have shown up there and she could have said, ‘You have pneumonia, continue your antibiotics,’ and sent him home, and Chris probably would have died.” She adds that the whole staff performed extraordinarily. “Being a nurse myself, I take care of viruses and illnesses that I have studied extensively, and I know my risk, and I know my PPE needs. This was something that they knew nothing about and had to learn really, really fast. So those first people that took care of him as a COVID patient, I just think are outstanding.”
For those health care workers, seeing Chris recover from the virus was a major victory, amid one of the darkest periods of their lives. “That was really a big sigh of relief that we got somebody better and that sort of set the tone somewhat for what became a very difficult six to eight weeks from there,” Chronakos said. Others echo that sentiment.
Two months later, in early May, the protocols for treating coronavirus had changed since the state saw its first patient, and they continue to evolve rapidly, Nee says. “Every week I think I know the virus and then at the end of the week I’ve learned something new. When we went into this in March, we had experience from China and Italy. We initiated early intubation, tried medications with potential antiviral activity. Today, we’ve learned to perhaps avoid intubation by using various oxygen-delivery devices. At times, we still use antivirals, but we also try to block aspects of the immune response which are detrimental to lungs with specific medications. We also have found high rates of thromboembolic events [blood clots leading to pulmonary embolism or stroke], so some patients get blood thinners to prevent those clots.”
The hospital is also involved with several ongoing trials for potential new treatments that patients can opt to enroll in.
In mid-April, Nee had a respite from the coronavirus surge at his hospital and had time to call Chris to speak with him for the first time since he left the hospital. “I filled him in on some of what happened behind the scenes,” Nee says. “He told me of his recovery and his experience. As a physician those 40 minutes were the best and most satisfying minutes of this whole crisis.”
Chris enjoyed the conversation as well and says that he prefers the focus of the story of his recovery be on the health care workers. “I didn’t do anything other than take benefit from their care. They’re the people that should be getting the praise.”