When the Doctor Became Critically Ill

By Todd Abrams

In October 1999, Dr. Harvey Serota was 42 years old, in a successful four doctor practice in interventional cardiology. It was his turn on call that weekend, and his wife Pearl was away visiting friends in New York. On Friday he started feeling achy and had a fever. On Saturday he went to work at Christian Hospital as usual, did an emergency surgery on a heart attack patient, then started feeling sweaty, still had a fever and now chest pains. He took Vioxx to knock the fever down.

Early Sunday morning he did hospital rounds but started feeling sicker and was having trouble breathing. He was in the basement of the hospital when he knew he had to immediately make a decision – to get an X ray or go to the Emergency Room. He walked into the ER through the doctors’ entrance, where all the doctors knew him, and they quickly determined that he was too sick for triage and was sent immediately to the Trauma Room. With his chest pains they knew he had pneumonia even before the X-rays came back.

Acute respiratory distress syndrome

Dr. Serota called his partner to finish his rounds for him, was put in a private room on oxygen and antibiotics and expected to go home in a few days. But it was soon determined that what had started out as pneumonia in one lobe of his lung had become acute respiratory distress syndrome, a serious lung condition in which blood vessels in the lungs become leaky and have trouble oxygenating. He was given more oxygen, but his blood oxygen level kept dropping.

Dr. Josh Glaser, a general surgeon friend, visited him in his room, told him that he didn’t look good and put him in the Intensive Care Unit. When attendants in the ICU asked for the name of Dr. Serota’s patient, Dr. Glaser said, “It’s Dr. Serota himself.”

Two or three days of oxygen by mask was not working; his blood oxygen levels were still too low. Dr. Serota asked to see his X-rays, which showed his lungs as solid white, meaning that the infection and fluid had spread everywhere. He called his family and agreed to be put on a ventilator.

When oxygen levels are that low, oxygen through a mask and sedation are not enough. On a ventilator you’re knocked out and totally immobile so that muscles don’t consume oxygen that is needed by major organs to keep the patient alive. His wife, Pearl, a psychiatrist, quickly came back from New York and stayed with him in his room for the next three weeks. Another friend from the hospital, Ahmed Jafri MD, a neurologist, gave instructions for keeping his limbs moving and turning him frequently to keep his joints from freezing up, so that when he recovered, he would have normal movement.

Prayer and prone ventilation

During Dr. Serota’s 35 days on the ventilator, the hospital chaplain arranged for an interdenominational prayer service in a conference room. Some close friends showed up with an Orthodox rabbi, who held a service in which Dr. Serota’s Hebrew name was changed, a tradition based on the ancient belief that a person’s name is the spiritual conduit through which blessings are received. If death had been decreed for one individual, by changing the name, he or she becomes someone else, not the one decreed for death. His name was changed to Raphael, which means “God has healed.”

During this time, Steven Hadzima MD, Vice President of Medical Affairs at the hospital, brought in Dr. George Matuschak, an expert in acute respiratory distress syndrome, who also was a professor at St. Louis University School of Medicine. He agreed that everything was being done correctly by Dr. Myron Jacobs’s team but wanted to try something that was new at the time called prone ventilation, in which the patient is placed face down to improve oxygenation.

After 35 days on the ventilator, Dr. Serota’s condition began to improve, he was put on his back and sedation was reduced. While sedated he managed to chew through the ventilator tube, separating the cap that keeps it securely directing oxygen into the lungs. He had to have an emergency extubation to take the tube out. His doctors didn’t know if he would be able to breathe on his own or if the next step would be a tracheotomy, a surgical procedure in which an incision is made in the front of the neck and a breathing tube is placed into the trachea, or windpipe. He was able to breathe on his own and didn’t require the normal weaning process from the ventilator, although he was having hallucinations and seeing double. After having been essentially paralyzed for that long on the ventilator, Dr. Serota’s muscles were very weak – he couldn’t roll over, brush his teeth or even lift a towel. His resting heart rate was 110 beats per minute, about twice normal. He couldn’t do even the simplest things; his handwriting went back to grade school level. But he started long-haul physical therapy with a passion: instead of the recommended three hours a week, he worked at it eight hours a day.

His doctors had told him that his recovery would take six months, but he said he had a family and patients to take care of. His recovery took six weeks of painfully working with a trainer every day.

How the experience affected him

On reflection, Dr. Serota believes that the entire ordeal made him much more sensitive to what patients go through. Many doctors have no idea how painful, both physically and mentally, treatments are. For instance, he learned how much shots of the blood thinner Heparin really hurt. Instead of giving the customary three shots of Heparin he now gives one shot of Lovenox or one pill of Xarelto.

The experience reinforced for him the importance of a doctor who practices with deep experience in the basics of his or her specialty, but who is also up to date with new techniques like the prone ventilation that was used for him, and which became a very important procedure during the Covid epidemic.

Dr. Serota has even changed how he talks to patients. Once during his recovery, he was ambling about on a walker in the hospital when his doctor came up to him and said, “Harvey, you will probably be OK.” He said he collapsed when he heard the word “probably” – it made him fall to his knees. Patients need to go into surgery and recovery with a positive attitude, so he now errs on the optimistic side. He would rather give patients a positive statement and be wrong than deny them the hope that can help in their healing. And having been through so much himself, he is inspired by some people with terrible diseases who still manage to stay positive.

He even has a different perspective on hospital food. Patients always say hospital food tastes bad, but he realized that it is because they are sick, or the bad taste can be a side effect of medications. Pearl brought him dinner from Tony’s one night while he was in the hospital, and he says even that didn’t taste good.

Dr. Serota also gained a much greater appreciation for the need to exercise regularly, to be in good physical shape in case something happens to you. Patients who have good muscle strength do much better in recovery than those who don’t. During the Covid epidemic it became readily apparent which patients were more likely to survive – those in better physical shape when they became ill. And he understands much better now how important physical therapists are – he says they are among the most important people working in the hospital. Walking every day and other forms of rehab are critical.

From a personal relationship standpoint, the experience also gave him a richer sense of enjoying relationships of those who are important to him, and he accelerated the timetable for doctor employees in his practice to become partners. He also became much closer to family and friends, balancing work with the rest of life. He learned that you have to find time for yourself and for doing those things you enjoy.

When I asked Dr. Serota if he had any idea how he became vulnerable to the virus that caused his critical illness, he said that back in those days he did not take care of himself; he didn’t exercise regularly, and would rush around outside even in chilly weather, sometimes exhausted and dressed just in scrubs. He reflected that he hadn’t listened to his mother, who always told him to dress warmly.

Just for the record, on the day I interviewed him we were indoors in late April, and he showed me the skier’s long underwear he now wears under his clothes.

Dr. Harvey Serota, MD, FACC, FSCAI, is a board-certified cardiologist in internal medicine, interventional cardiology, and cardiovascular disease at St. Louis Heart & Vascular.

Above: Dr. Serota with his daughter Danielle.

Middle: Dr. Serota with his father Ely Serota and daughter Danielle.

Below: Dr. Serota with his daughter Danielle and son Joshua