In sickness and in health, till death do us part ...
They grew feverish together. Both David and Charlunda Thompson were coughing, too. They were indescribably tired.
David, 42, a middle school math teacher, noticed in mid-March that he could no longer smell Charlunda's cooking.
Charlunda, 45, a hospice nurse, said her sense of taste and smell had changed, too. Everything took on a flowery cast that made her stomach churn.
They knew COVID-19 had them in its clutches, but neither realized just how hard the virus would hold them in its grip.
The couple has done almost everything together since June 17, 2000 — when they vowed to love one another through all of life's challenges at the Inkster church where they'd met.
They both sang in the church choir. They adopted a 17-pound mixed-breed dog they named Baby Fiona. Charlunda finished nursing school and launched a medical career. He cared for her when she was struck by a car, and needed multiple surgeries. The Thompsons also bought a fixer-upper about three years ago that they hoped would become their dream home.
But for 45 days this spring, the Thompsons couldn't hold hands, couldn't hug one another, couldn't even be in the same room.
They feared they'd lose each other to the novel coronavirus, which so far this year has killed more than 4,500 Michiganders and 79,000 Americans, and sickened millions globally, including several members of their church, Pilgrim Traveler Missionary Baptist.
"I just felt so terrible ... in complete honesty I didn't think I was going to live," David said.
The symptoms came on hard and fast, and within a few days, Charlunda was admitted to Beaumont Hospital in Dearborn, where she remained for almost a month. She spent 16 days on a ventilator.
Her husband nearly died at home. The day after Charlunda was admitted, David's worried sister called 911 after he didn't answer her repeated phone calls. Another relative rushed to the house to find David unresponsive. An ambulance took him to Beaumont Hospital in Wayne, where he was treated for eight days.
"I remember just praying so hard and asking God to just work things out. Work things out, Lord, please," he said. "But, you know, doubt creeps in. What the COVID virus does is it just, it tries to break you down. It's unrelenting. It wants you to just give up."
Although the virus presents with mild symptoms in the majority of people, in others, its wicked attack deprives them of oxygen, leaving them devastated by muscle wasting, memory loss, cognitive impairments, kidney, heart and lung damage and increasingly, blood clots.
Although the Thompsons are among the more than 22,686 Michiganders who are considered recovered from the coronavirus, the couple said they feel as if they barely escaped death.
And it'll be a long time before their lives once again bear any semblance of normalcy.
"I took for granted that tomorrow will always come," David said, "but the virus put me in a position to where ... I had to realize and reflect that, hey, that's not a guarantee."
A worried sister prompts the Thompsons to get help
Dr. TaLawnda Bragg was worried.
Her brother didn't sound like himself, and neither did his wife.
It was March 22, and both David and Charlunda had been sick for a few days with symptoms that were consistent with COVID-19. On that Sunday, they both seemed more lethargic than normal and short of breath.
She made the assessment by phone because she lives 150 miles away in Caledonia, on the western side of Michigan.
Bragg, a hospitalist at Spectrum Health in Grand Rapids, knew that Charlunda has an autoimmune condition called vasculitis, which causes inflammation of blood vessels throughout the body, and was being treated with medication that suppresses her immune system. David has Type 2 diabetes.
"Most people with COVID-19 — about 80% of the people — will do OK at home, but there's a very select few that will have severe disease," Bragg said. "And we already know that African American people, especially people with comorbidities, are at risk for decompensating, and having more sickness from COVID, being intubated in the ICU (intensive care unit) and even dying from COVID."
She urged David and Charlunda to go to the hospital.
"It was horrible," Charlunda recalled. "It was very hard to breathe. I felt like I was a dog panting for water. I had a fever of 102.4. I was coughing, the dry cough, body aches, sweating, chills, just pretty much ... textbook" coronavirus symptoms.
Charlunda's sister drove them both to Beaumont Hospital, Dearborn, where a curbside screening had been set up outside.
"They screened Char and her oxygen level was low," Bragg said. "David's oxygen level was not low yet, although he had that fever, the cough, the shortness of breath. So based on what may sound like a very arbitrary set of criteria, they felt that he would be OK to go home, self-quarantine and manage his symptoms."
At that time in March, most metro Detroit hospitals were filling up with patients who were sick with coronavirus as the region's surge in cases began. Bragg knew that nurses and doctors had to make quick decisions at the curbside about who most needed hospital care and who could go home.
David said goodbye to Charlunda, uncertain about what the future would hold.
"It was really difficult because we've been together for 20 years," he said. "I'm so used to having her by my side ... just like peas in a pod."
Knowing her brother was very sick and at home alone, Bragg called to check on David every hour or two to make sure he was OK.
Within 24 hours, it became clear to Bragg that her brother needed more help than she could offer him by phone.
"One of the things that I started to see was that he was starting to become more sleepy and a little bit more confused," Bragg said. "And that was my trigger that we are not going to be able to handle this at home and he's likely worsening. My concern was this hypoxia, this low oxygen level caused by the severe COVID pneumonia.
"So I called EMS from Grand Rapids and I was able to have them come to the house."
Bragg also called Charlunda's sister, and asked her to check on David.
David didn't answer the door. He stopped answering Bragg's calls, too. They believe he'd passed out.
Bragg said she instructed Charlunda's sister to bang on the windows and doors to try to rouse David before emergency medical help arrived. It worked. He was confused, but David came to the door, and they waited together.
"He was in pretty rough shape," Bragg said.
Using FaceTime, Bragg was able to virtually see what was happening and communicate with the emergency medical response team who took David to Beaumont Hospital in Wayne, where doctors told him that he had double pneumonia and kidney failure, he said. His oxygen levels were dangerously low, too.
"I'm convinced that if we had not intervened on that Sunday, when they both went to the hospital, they would have died in their home alone," Bragg said.
Fear and prayer before the ventilator
In a hospital bed about 10 miles away, Charlunda was struggling.
Just three days after Charlunda was hospitalized, she called Bragg to tell her it had become so hard to breathe, she felt ready to be put on a ventilator. She asked her sister-in-law to help her understand what to expect.
"She said she felt like a fish out of water," Bragg recalled. "So I said, 'Let me call Dave.'"
David was still in the hospital about 20 minutes away, also growing weaker.
"... There was such a sense of urgency because she was decompensating so fast. So, the three of us were on the phone together. We prayed. We read Scripture. David told her to be of good courage," Bragg said. "And the interesting thing about it is David was so sick he does not clearly remember this conversation at all. But, again, the use of technology has allowed us to be connected, even though we were far apart."
It was Wednesday, March 25.
David said that even though his own memory of what happened is spotty, he won't ever forget thinking about the statistics he'd read about people with COVID-19 who need to go on a ventilator: Most don't survive.
"When my sister told me that they were putting her on the vent, man, I didn't think I would be able to manage life without her. It was just, it was so hard," David said. He told Bragg about their life insurance policies and advance directives in case they didn't make it out of the hospital alive.
"I remember seeing on the news that once you get on the vent, you've got a 20% chance to survive. I said, 'Well, those aren't good odds.' But I remember saying to myself, my wife is a fighter."
For 16 days after that, Charlunda lay in her hospital bed as a ventilator did the work of breathing while the virus ravaged her body. Though she was sedated, the staff at Beaumont got her sister on the phone, and held it to her ear while her sister spoke so Charlunda would know that her loved ones were nearby.
"The next thing I remember is waking up in ICU intubated," Charlunda said. "I don't remember getting in trouble. I don't remember getting to the point where I needed to be intubated. But I just remember waking up in the ICU, restrained, of course, so I wouldn't pull the tubes out.
"It was kind of scary. I thought maybe I was intubated for two days. Come to find out ... it was 16 days total."
While a ventilator can save lives, it also can wreak havoc on the body, said Dr. Ralph Wang, the lead rehabilitation physician for the ReCOVery Unit at Mary Free Bed Rehabilitation Hospital in Grand Rapids.
"On top of COVID, prolonged ventilatory status kind of creates another disease process of its own," he explained.
Being immobile for such a long time leads to muscle weakness, and it also can cause the skin to deteriorate, allowing wounds to form.
"And then sometimes when you're also on the ventilator for a while ... you might acquire something called neuropathy, where actually your nerves kind of shrink and get sick and such, which makes the rehab ... even longer," Wang said.
There also can be cognitive effects and memory loss.
Many patients who have long stays in the ICU on ventilators, like Charlunda, need extensive therapy to recover enough to safely go home.
When Charlunda showed enough signs of improvement to come off the ventilator, she said it was painful to breathe. Her voice was a squeaky whisper. Sitting up was hard, standing was harder.
"I think the only thing that really, really hit me hard was a fear that I would not be able to walk again," Charlunda said. "That and the initial inability to really take a deep breath because it hurt. It hurt to take a deep breath."
And because she had coronavirus, she could have no visitors, no relatives or no friends by her side at the hospital.
The staff at Beaumont tried to fill that void. As she slowly improved, Charlunda noticed they had put up pictures of her and David on the wall. And if friends or family called while she was asleep, her medical team wrote their messages on a dry-erase board so she could read them.
"They were phenomenal," she said. "They really were. Those little things make a difference because it lets you know even though they're not here, they're thinking of you.
"The people on the front line ... are amazing," she said. "And I'm grateful that you all are sacrificing ... to help us."
A rocky return home
David never needed a ventilator, though he remembers being told at one point that doctors were considering it for him.
He said he fought the virus with every ounce of his strength, refusing to let it win.
"This thing, it's deadly," he said. "It's unrelenting. ... It doesn't want to let you go. It wants to hold on. It wants you to give up. It wants to really make you so tired that you ... don't want to wake up, you know? But you got to fight it. You got to fight it.
"It takes prayer. It takes faith. It takes every ounce, every fiber of your being to come through it. And not just your being, but your loved ones, your friends. ... I thank God for all the people that were praying for me, my co-workers, you know, just everyone praying for me. And that's what you have to do. You know, you have to do all of these things in order to defeat this virus."
David's homecoming after eight days of hospitalization was rocky.
"I still wasn't quite ready," David said. "I wasn't mentally stable. It's like my memory just continued to go in and out, in and out. ... And I laid in my bed about a week, week and a half. I could barely move. ... I couldn't make it to the bathroom."
So he put a trash can by the side of the bed to use as a commode.
Although family checked in on him and delivered groceries to his door, David said he drank Gatorade and ate little more than hot Cheetos the whole time — they required no preparation and were the only things he could taste.
Bragg realized he needed therapy to get better, too, but there weren't many options for him or Charlunda at that time. Hospitals around the state were following Gov. Gretchen Whitmer's executive order to cancel nonemergency medical services and rehabilitation facilities were reluctant to admit COVID-positive patients.
"There were no options on the southeast side at that time," Bragg said.
Mark Geary, a spokesman for Beaumont Health, said patients who had coronavirus weren't being admitted to skilled nursing facilities for rehabilitation when David was discharged "due to extreme caution to protect seniors residing in those facilities.
"Now that more is known about how to manage COVID-19 patients once they have progressed through the acute phase of the illness and are ready for discharge, skilled nursing facilities can safely admit these patients while maintaining established infection-control precautions," he said.
In late March and early April, Mary Free Bed Rehabilitation Hospital wasn't taking those patients, either.
"Initially, we felt like we needed to defend this place from COVID, and not have it here," said Dr. Michael Jakubowski, Mary Free Bed's chief medical officer. "If somebody had COVID, we felt like they needed to be in acute care, and then we would take them when they became free of COVID.
"But it just really became clear ... the community need was to help people who are wracked by this, who were deconditioned and weak or had any of 15 different huge issues which were impacting their ability to get out of hospital.
"We said if we can't do it here, then it can't be done."
Within about 48 hours in mid-April, the hospital came up with a plan to create a separate unit for COVID-positive patients in need of rehabilitation. It would allow them to benefit from individual and group therapy as well as support groups to help them relearn the skills they'd need to live on their own again.
"That came together very quickly and we can manage fairly sick patients," Jakubowski said. "We still believe that patients need to be getting better to come here so we can push them ... but it is very unusual for any hospital to be taking on other hospitals' positive COVID patients. We feel like the community owns us. This is what the community needs, and the community has made this rehabilitation possible."
Mary Free Bed now has 18 dedicated beds to rehabilitate COVID-positive patients. As people begin to recover from coronavirus, and are no longer contagious, they are transferred to regular, non-coronavirus rehab units so they can continue to build muscle strength, balance, lung capacity, speech, and cognitive skills.
"We're keeping very strict criteria on that, but if they're (testing COVID-19) negative, and we would send them home with no special precautions, then we're going to send them out into the rest of the hospital," Jakubowski said, until they're ready to go home.
"Instead of treating them like they're going to poison somebody, these are people who have demonstrated that they can beat the virus. They are getting better. They are possibly the safest people in the whole community to be around. So let's not shun them. Let's congratulate the fact that they're able to stay with us in the human family."
By the time Char was ready to be discharged from Beaumont in Dearborn, Mary Free Bed was accepting patients like her.
Bragg made some calls and got her sister-in-law in.
Metro Detroit patients get help outstate
Charlunda remembers bits of the long, bumpy ride in the back of an ambulance from Dearborn to Grand Rapids as she was transferred to Mary Free Bed.
She said she slept through most of it. She's among several patients from metro Detroit who have been admitted to Mary Free Bed for coronavirus rehabilitation.
"She was really improving at the height of the COVID-19 crisis over there," Bragg said. "Figuring out where the patients go when they leave the hospital was very difficult. A lot of the places either weren't accepting COVID-19 patients or there just wasn't any availability.
"She didn't have many options on the east side of the state."
Ascension Michigan began offering in-patient rehabilitation for COVID-19-positive patients a day after Charlunda was moved to Mary Free Bed.
Henry Ford Macomb Hospital also was offering in-patient rehab for coronavirus patients who'd been stabilized, but of the 28 people who received step-down care there in the month of April, all came from within the Henry Ford Health System.
At Mary Free Bed, the medical staff and other employees working in the ReCOVery Unit must walk down a long, outdoor terrace that separates the "clean" side of the hospital from the COVID side.
They don N95 masks, face shields, gowns, caps, shoe covers and gloves. A registered nurse sits by the entry to ensure every person who enters is properly protected.
And when they leave the coronavirus unit, that same nurse checks to see that they take off the gear the right way to reduce the risk of infection.
Patients can walk freely throughout the unit because they all have coronavirus.
"We think of this as a respiratory virus, but the primary issue is that ... even for young and healthy people with good muscles, good lung function, they're not oxygenating well," Jakubowski said.
"We are seeing people who are exhausted by trying to get out of bed to get to the bathroom. ... We're seeing a lot of people who have been assaulted by this with renal failure. They never had kidney disease, and now they're on dialysis or, or they have been in an ICU for so long and have been unconscious that either the virus or their stay in the ICU has impacted their higher cognition skills at least temporarily.
"And then there are a lot of people who are wasted with neuropathy and myopathies who are just going to need time and energy to get that back up.
"These people just want to go home. So what do they need to do to get home? They need to do what all of us do in the morning, get out of bed, get to the bathroom, eat, get dressed, get cleaned up. When they can do that well enough, they should be at home."
Occupational therapists help them learn to use handheld grabbers to reach things in high places and low places, how to fold laundry, independently take a shower while conserving as much energy and oxygen as they can.
Tina Monahon, a speech therapist, helped Charlunda learn to sing again.
"Char was dealing with some reduced respiratory supports," Monahon said, "and we're seeing that a lot with the COVID patients, where there is just a lot of shortness of breath, reduced ability to project their voice."
She uses interval training to help their recovery.
"So, they'll do something for a short period of time and get winded very, very quickly, and oxygen saturation will start to drop," she said. "And so, we've been doing a lot of respiratory exercises. ... Char likes to sing, and she has an amazing voice. And so, we've incorporated even some of that into our therapy activities."
At her session on Tuesday, Charlunda belted out "Thank You For Being a Friend," the theme song from one of her favorite shows, "The Golden Girls."
"I feel like it is very good emotionally for the soul, getting back to doing some of those things that she really enjoys, and being able to use that gift of her singing to ... help with her respiratory status as well is really amazing," Monahon said.
With a physical therapist, Charlunda practiced climbing up and down a short stack of steps, balancing while standing with her eyes closed and weaving in and out of colorful cones set up on the floor, tapping her foot on the top of each one as she passed.
She built up her capacity to stand, to walk and to carry things with the hope that she'd be able to help David make a steak dinner with a big salad when she gets back home.
Every Wednesday, the hospital hosts a coronavirus support group, said Dr. Yunna Sinskey, who said it was humbling to listen to the conversation.
"All of them were on the verge of death. All of them had been intubated," she said. They laughed, and were encouraging to one another as they talked about their worries and fears about returning home.
"There were a lot of tears and a lot of laughter. The laughter was the best part. It doesn't happen a lot in critical care," she said.
"The big thing I didn't realize even as a physician was that ... there's a fear of even returning home," she said, noting that many of the patients haven't been out in the world since before the governor's stay home, stay safe order was put into place.
"Returning home is terrifying to them because they don't know if they're going to get rejected," she said. "How are people going to react to them returning home? Is their neighbor going to allow them to even come up to their house?"
Charlunda downloaded an app on her phone to count down the hours, seconds and minutes until she could leave Mary Free Bed and be home again with David.
They FaceTime one another every day, and earlier that week, they fell asleep together virtually.
David has been doing virtual therapy remotely for the last couple weeks with a Mary Free Bed physical therapist, trying to reduce his own supplemental oxygen needs, and build his stamina.
Part of his therapy is dancing to "Old Town Road" and walking down his street — measuring the distance by houses. At first, he could walk only as far as a house or two. Now, he's up to 10 houses.
Charlunda will join him, also doing continuing therapy with her Mary Free Bed team remotely from home.
An emotional, long-awaited reunion
On Wednesday, David pulled up outside Mary Free Bed Rehabilitation Hospital in Grand Rapids in his black Kia Sportage with a pulse-oximeter wrapped around a finger on the hand that held the steering wheel. An oxygen tank rested on the front seat.
With a nasal canula pushing oxygen into his nose, and a mask over his face, David climbed out of the car, prepared to greet his wife and bring her home for the first time since March 22.
They stood in the shade of the canopy-covered drive and he put his arms around Charlunda. They both sobbed.
"I'm just so grateful that I still have him," she said.
"I love you, baby," he said. "... You scared me. I was scared. I was so scared."
She wiped his tears and said, "It's OK. It's all right."
Charlunda said she wouldn't have been ready to go home if it weren't for the intense rehabilitation she underwent in the new specialty unit for COVID-19 patients at Mary Free Bed.
Slowly, she's weaning off supplemental oxygen, too. Charlunda doesn't need it when she's resting anymore, and only uses the added oxygen when she's doing activities that elevate her heart rate. Both David and Charlunda now test negative for the coronavirus.
On Wednesday morning, as she packed her things and got ready to be discharged, Charlunda was asked whether she wanted to be pushed out in a wheelchair.
"I chose to walk," she said, smiling broadly.
The door of the ReCOVery Unit opened to the bright May morning sun, and Charlunda took her first steps toward a normal life.
Medical staff lined the path, cheering as she walked.
David was waiting, she couldn't get to him fast enough.
He opened the passenger door of the SUV and helped her get inside for the 2½-hour drive home to Inkster.
"It's been a journey," Charlunda said. "And I know I have a long way to go. But I can do it. I can do it."
Health Reporter Robin Erb of Bridge Magazine contributed to this report.
Michigan Radio, Bridge Magazine, and The Detroit Free Press are teaming up to report on Michigan hospitals during the coronavirus pandemic. We will be sharing accounts of the challenges doctors, nurses and other hospital personnel face as they work to treat patients and save lives. If you work in a Michigan hospital, we would love to hear from you. You can contact reporters Robin Erb firstname.lastname@example.org at Bridge, Kristen Jordan Shamus email@example.com at the Free Press and Kate Wells firstname.lastname@example.org at Michigan Radio.