Living with the scars of COVID-19
39-year-old spent 12 days in coma after coronavirus savaged his lungs
For Carmine Posteraro, there is no escaping the reminders of the virus that nearly claimed his life.
He feels it with every step he takes and every laboured pump of his lungs. It’s there every time he tries to read something or watch television. It stares back at him in any mirror he looks at.
For 12 days in March — as the COVID-19 pandemic washed over Niagara in earnest — Posteraro laid unconscious on his stomach in a Niagara Health hospital bed. In the neverland of a medically induced coma, a ventilator did what his lungs no longer could: breathe for him.
That ventilator left its mark on his lungs. Even now, weeks after returning home, he is short of breath. And a line from the machine dug into his face, leaving an angry red brand on his cheek.
His left leg is numb, impairing his ability to walk, and his vision is blurry: Both conditions an echo of the machine that saved his life.
“People need to know this thing is real,” Posteraro says. “I’m young still. I’m 39. But people need to know what this virus can do to them, and not think because they are not a senior citizen they are safe. They aren’t.”
Recovering from this ordeal in the home of his mother, Rena Posteraro, in Niagara Falls, he says he would not have survived his encounter with the novel coronavirus without the paramedics, nurses and doctors who fought the illness on his behalf.
“They were great,” he says. “I cannot say enough about them. The team at Niagara Health was amazing. They treated me with dignity and saved my life.”
March 20, the day Posteraro began to show symptoms of COVID-19, was supposed to be the start of a new chapter in his life. He had just completed a six-month stay at a Christian rehab facility in London, Ont., to put an end to his use of fentanyl. He was returning home to Niagara Falls to start over, clean and ready for the future.
So he didn’t immediately pay much attention to the rattle in his chest.
“Of course I knew about COVID-19, but I did not expect that I had it,” he says.
When he arrived home, Posteraro got a call from the rehab centre. One of their staff had tested positive for it. They recommended he get tested.
“It was so frightening,” Rena says. “I just got my son home, looking toward the future, and
you get this call.”
For Posteraro, it felt as though the universe had it in for him.
“It was a scary moment for me,” he says. “I’ve experienced overdoses, and as a result I am prone to pneumonia.”
He was tested in Niagara Falls on March 23 and his breathing was getting worse.
That was a Monday. By Wednesday, March 25, Posteraro says he was in “severe respiratory distress.”
“I couldn’t breathe,” he says. “I was coughing up this black phlegm. It was coming out of my nose.”
The test result — which would confirm his COVID-19 infection later that day — had not been reported yet. Posteraro said he wasn’t keen about getting into ambulance again. It triggers memories of a life he was leaving behind. But his mother insisted, as only mothers can.
“I told him that we cannot play around with this,” she says.
He entered the ambulance to a team of paramedics dressed in full PPE when they arrived. It would be the last steps he would take for weeks.
“They had to intubate me in the ambulance on the way to the hospital,” he says. “My oxygen saturation was down more than 70 per cent.”
The tube inserted into Posteraro’s mouth and down into his airway allowed paramedics to pump oxygen into his lungs.
The rest was a whirlwind. Doctors were worried he wasn’t getting enough oxygen. His lungs were too badly compromised by the pneumonia caused by the virus. He would have to be moved from the emergency department at Greater Niagara General Hospital to the ICU and placed on a ventilator.
“Fear came over me at that point,” Posteraro says. He was surrounded by nurses and doctors whose faces were hidden behind shields and masks. His family could not be at his side. He worried this was his end.
His lungs were so badly compromised, doctors put Posteraro into a chemically induced coma to allow the ventilator to keep him alive. Unsure if he would ever see his mother again, Posteraro slipped into darkness.
“Sometimes you need to induce the coma so the patient does not try to fight the ventilator,” said Dr. Jennifer Tsang, a Niagara Health intensivist who treated Posteraro. “It gives the patient the best chance for survival.”
Tsang said when COVID-19 successfully attacks the lungs, a patient simply cannot get enough oxygen. In many cases, she says, the patient has a powerful but dry cough. Nothing is coming, and nothing is coming out.
“But in some cases, the patient is coughing so hard that it can cause damage to the lungs, and so that black phlegm is probably blood,” she says.
While a ventilator can keep a patient alive, its use comes with consequences. The machine can cause serious damage to a person’s lungs.
The longer they are on it, and the older the patient, the more severe that damage can be.
Doctors do have ways to try to mitigate the damage, including placing a patient on his or her stomach, but some degree of lung injury is likely.
Tsang calls a ventilator a “double-edged sword.” With no effective treatments or cure to attack the virus itself, doctors can only manage a patient’s symptoms and hope their immune system can mount an effective counterattack on its own.
“If you are over 42, the outcome is substantially worse,” says Tsang. “That seems to be the cut-off where, after that, a patient does not fully recover (their lung function after being on a ventilator).”
Posteraro’s lungs were not the only organs impacted by the ventilator. It also caused kidney damage, and he was hooked up to a dialysis machine.
While he slept, he was moved from Niagara Falls to unit 4A of the St. Catharines hospital, where the region’s most serious COVID-19 patients are treated. And all his mother could do was wait.
No visitors are allowed on unit 4A. The risk of contagion is too high. The closest she could get to talking to her son was via daily phones calls with nurses.
“They were so amazing and comforting. So I knew he was in good hands,” says Rena Posteraro. “I prayed a lot.”
Five days after Carmine was taken away in an ambulance, Rena’s husband, Dominic, tested positive for COVID-19 and had to be admitted to unit 4A. While he, too, suffered from pneumonia, he returned home in a week.
After 12 days, Carmine Posteraro’s lungs rebounded. “When they woke me up, nurse Marina asked me if I knew where I was. I didn’t,” he says.
His hands shook too much to hold his phone to video-call his mother. Marina helped him.
“To be able to see him and talk to him … there was a lot of tears,” says Rena Posteraro.
He would spend another 10 days on the unit before returning home, and now faces months of rehab and visits to specialists to overcome the trauma to his lungs, vision and leg.
Although improving, he still can be overcome by fatigue.
Tsang says Posteraro’s prognosis is good. He is young enough and strong enough to recover.
But every day, he sees the scar on his cheek.
And he knows.
COVID-19 is something everyone needs to take seriously.