50 days in a coma, 128 days in hospital - but Grant McIntyre set himself a goal of getting back to work by this December
At the beginning of 2020, Professor Grant McIntyre was deep in meetings about the rolling refurbishment of Dundee Dental Hospital. Away from work he was looking forward to the possibility of a holiday in France, where he and his wife Amanda had been thinking about buying a property, and he was also planning a motorbike road trip with a friend along Scotland’s North Coast 500.
“But in the background, there was this nasty virus emerging from China,” he recalled. “Early on in the year, we sat down with Professor Ruth Freeman, the Consultant in Dental Public Health here, to ask the `what if?’ question.” In February, as COVID-19 spread from China, Grant and his colleagues studied the `swine flu’ pandemic of 2009 and the contingency plans that had been put in place in Dundee at the time.
“The parallels were quite striking, with tiered levels of restrictions from zero to four,” he said.
I had this constant vision of a python trying to wrap itself around my chest and kill me
As the weeks passed, they continued to monitor the spread of the virus and discuss potential responses in a weekly conference call. As it moved through Iran, to Europe and Italy, Grant recalls one day – Friday 13 March – as being a “key moment” at the hospital, when they debated stopping any contact with patients involving aerosol generating procedures (AGPs).
They subsequently received an email from the Scottish Government saying that this was a “gross overreaction” which would reduce patients’ access to care. “We had people at the top saying: `You must carry on as normal,’ when actually the information that was coming into us at the time suggested that this might not be the best course of action,” he said. “At the time, we took the middle ground of trying to avoid AGPs where possible, but not stop them altogether.”
Should that more nuanced approach to dentistry have been adopted by the Government throughout lockdown? “It’s a tricky one,” said Grant. “With the benefit of hindsight, the answer is often different to the one taken at the time But, looking at it objectively, without access to appropriate personal protective equipment, routine dentistry had to stop.”
By mid-March, the team at Dundee was meeting on a daily basis to organise a centralised urgent dental care service for Tayside. “There was one particular meeting towards the end of March where I was aware that several of us around the table were not in great shape physically and had a similar group of symptoms that in any other year would have been regarded as a cold or a mild flu. But as that week progressed, I lost my appetite, lost my sense of smell, was feeling increasingly rundown and, for the first time in 27 years, was unable to go to work.”
He had in earlier life suffered from mild asthma and now, at home, he thought he was having his first serious attack. His family called 111 and an ambulance arrived to take him to Ninewells Hospital. Grant was later discharged – after being tested for COVID, which subsequently proved positive. He was readmitted within a couple of days with similar symptoms, but again discharged.
Today, Grant has no memory of being admitted for a third time, as he drifted in and out of consciousness, on 31 March.
“What I do remember from then is, during the night, having a very bizarre ‘out-of-body’ experience where I was floating above the bed looking at a lifeless body below. When I realised it was me, I suddenly tried to pull myself together. I don’t know if it was an illusion or not, but I realised I was in serious trouble at this point and sat up in bed and tried to focus on breathing for the rest of the night; I had to concentrate on every breath.”
Grant, who is 49, was on supplemental oxygen at this point. “I remember that there was a consultant in respiratory medicine by my bed as I was having a chest x-ray done and thinking: ‘Consultants don’t normally wait for the results there and then, it’s usually the next day.’
“This guy isn’t here in the middle of the night for the fun of it, so I thought that probably wasn’t good news. The major thing for me was the profound breathlessness; each breath felt ineffectual, and the focus at that stage was purely on staying alive. I had by then conceded to myself that my life was shortening quite rapidly.
“I had a conversation with the consultant in the morning, saying that I felt I was going to die; I said quite openly to him that, unless we changed the treatment, I didn’t think I would survive the day. I asked him if I should be put on a CPAP [continuous positive airway pressure] ventilator. I guess, from working in the hospital service and the reading that I had done previously, I knew that it was the treatment of choice in this circumstance.
“It wasn’t a particularly long conversation; one of the junior doctors was despatched and in a matter of minutes I was being prepared for the move to the makeshift high-dependency unit. There, two consultants approached the bed, in full PPE, and said: ‘Right, we’re ready to go,’ and I was being anaesthetised. It’s the last thing I remember. I think the decision of the medical staff would ultimately have been the same, but the conversation I was able to have with them probably brought the timing forward.”
Initially, there were signs that his condition was improving. His blood- oxygen level increased. But then, he said, his body “crashed”. This pattern of hope, rapidly evaporating, will be familiar to those who have treated seriously ill COVID patients. Professor Grant would remain in an induced coma for the next 50 days and remembers nothing of this time.
However, from conversations he has since had with the intensive care and respiratory teams he knows that he was among a subgroup of patients with severe COVID-19 to experience cytokine storm syndrome1, characterised by “overwhelming systemic inflammation, hyperferritinaemia, haemodynamic instability and multiple organ failure”2.
While most people would be happy just to have survived, Grant’s medical curiosity has – now that he is home and able to read up on the phenomenon – been piqued. Perhaps more proactive treatment, particularly for younger patients with severe cases of COVID-19 – that concentrates less on symptoms of the virus and more on potential cytokine storm syndrome interventions, through heavy doses of steroids for example – could be a path to follow, he wonders.
He is also convinced, given the number of allergies he is now aware that he suffers from, that there is a connection with so-called exacerbated allergic response. I ask if he is going to write a paper on these areas of interest. “Speaking to one of the respiratory consultants, I think they are ‘writing me up’ already,” he joked.
But at the time, his condition was no laughing matter. The intensive care team in Dundee consulted with peers at a number of other centres and it was decided that, given his relatively young age, he could be put forward for a treatment known as extracorporeal membrane oxygenation (ECMO), often used on critically ill babies or children awaiting transplants, in which the patient’s blood is circulated through an artificial lung, back into the bloodstream.
There are only two ECMO centres in the UK, in Leicester and Aberdeen – and space was found in the latter. A so-called ‘retrieval team’, of doctors and nurses, travelled to Dundee and readied Grant for his journey north by road. It was a challenge for the team – and, throughout his time in Aberdeen, for his family.
Grant says that even now, neither clinicians nor family have shared the full extent of the experience for fear it will affect his mental health. He does know that he suffered multi-organ failure. He was put on dialysis. There were concerns for his liver, his heart. He suffered a small stroke.
“In my mind I categorise them as a series of medical disasters that were so unfortunate, but that somehow the doctors and nursing teams seemed to get me through each one without any long-lasting effect.”
Although he remembers nothing of this period, his family could occasionally see him via FaceTime. “Apparently, I was able to communicate in some ways, such as by blinking or lifting my fingers, and that on my son’s 21st birthday there was some conversation but, sadly, I have no memory of that.”
He was on the ECMO for 42 days, then transferred back to Dundee and it took about a week for him to regain consciousness. “I go back to that time quite often; not to pore over the details but, to me, it was astonishing because I remembered going to sleep in the high dependency unit and now, I was waking up in a different part of the hospital. I didn’t know where I was, who I was, or any of the people around me. I didn’t know if it was day or night because the area had been requisitioned from a theatre recovery suite where there were no windows.
“As time passed, I began to have some rather strange, and perhaps unhealthy, thoughts. The walls and the ceiling appeared to be moving inwards and outwards. Lying there, I started to see animals coming out of the ceiling. I had this constant vision of a python trying to wrap itself around my chest and kill me. I think there is a clear correlation between that vision and my recollection of difficulty in breathing before I went into intensive care.”
By this time, Grant had been given a tracheotomy. From a nearby radio, news of the murder of George Floyd by police in America drifted into his consciousness. “I became convinced that the tracheotomy was a knee on my neck. I couldn’t make the distinction between those who were there trying to help me and what I imagined was happening to me.”
When the tracheotomy was eventually removed, he was able to discuss his experience with a clinical psychologist. “I was aware that my mental health was not as it should be, so I had some sessions with him and that was very helpful.”
Unable to see his family, the medical staff “spent hours with me,” said Grant. He was worried that he was becoming “a victim of myself, perhaps causing myself more damage psychologically than COVID had done physically. I was conscious of the effect and tried hard to counter it, but it just kept turning on me every time I went to sleep. I try to see the positive now; I wonder whether it is just an over-active mind. But I think the important thing now is to recognise the potential impact on mental health and that there should be no stigma attached.”
He also asked to speak to the hospital chaplain.
“I was aware that my family, friends and colleagues had put in this extraordinary amount of positive energy and I felt it was the time for me to have a very open conversation about faith. I have not attended a place of worship regularly, but I do have an underlying faith and at that moment – of trying to reintegrate with the world – it was time for me to acknowledge that other people’s faith, as well as my own, had played a part in getting me to that point in, ultimately, one piece. I am grateful to everyone for their support and their prayer, and, of course, for the skill and dedication of the doctors and the nursing staff.”
After many hours and days of work with medical and support staff, Grant was able – still with a myriad of tubes and cables attached – to be taken out of the same hospital door through which he had arrived and see his wife for the first time in more than three months. “It was only 10 or 15 minutes, but it will stick with us for the rest of our lives – probably one of the most important times that we have been together,” he said.
“And for her to see signs of physical progress after such a long period of time, to tell the children and the rest of the family must have been fantastic.”
Other visits outside followed, from his children and his brother. “In my mind, at that point I had survived COVID and the medical Complications.” Recovery had begun in earnest, he said, and the focus was on rehabilitation, with the support of the physiotherapists, occupational therapists, dieticians, and speech and language therapists. “They were there, kickstarting me every day.”
When he was able to speak, his first words were to the medical team thanking them for saving his life. He then set himself goals; such as being able to sit up unaided in the bed, to stand (the latter achieved on day 86, when he was moved from intensive care to a general ward), and to take his first steps (day 100). His oxygen support was gradually reduced and around three weeks before he left hospital he was breathing normally.
Grant was discharged on 6 August. Today, a community-based rehabilitation team undertakes home visits. It’s not a linear recovery; he currently suffers from a form of reactive arthritis.
Grant is Clinical Director for the Hospital Dental Service in NHS Tayside, a Consultant Orthodontist at Dundee Dental Research Hospital and School, and an Honorary Professor at Dundee University. The doctors and rehabilitation team said he should take at least a year off from work.
But, last month, he told me: “I have set myself a target of December . So, the plan is to begin with non-clinical work, on a phased return, and as 2021 opens up move into doing some clinical dentistry; that is, ‘new referral’ clinics rather than any form of treatment.”
His colleagues have provided him with 3D models, hand-pieces and orthodontic appliances to help him in his rehabilitation; a way of regaining his general dexterity. “I’ve had to relearn how to breathe, to stand, to walk – I haven’t managed to run yet – and so I’m comfortable with the fact that I have to relearn dentistry.
“I like a challenge.”
Update: In 2021, Professor Grant McIntyre published a book about his experience; read the BDJ’s review here.