Nothing about COVID-19 medical treatment has been easy. Time and time again, the disease has confounded medical experts with its unprecedented behavior and patterns.
Leslie Cutitta knows this better than most people. Her husband, Frank Cutitta, recently became the subject of the latest COVID-19 medical mystery when he entered a “prolonged” or “persistent” coma.
Frank became infected with the coronavirus at the beginning of the pandemic in March. He soon required medical attention in the ICU. It took a small army of ICU caregivers and extreme life-saving measures to save Frank from becoming the next COVID-19 death. After 27 days on a ventilator, his lungs recovered enough to remove his breathing tube.
But he didn’t return to consciousness after a few hours, like most patients do. Even after the sedation drugs had cleared Franks’ system, he didn’t wake up. This marks another case of what doctors across the world are finding increasingly concerning: a phenomenon associated only with COVID-19 in which some patients, even after extubation, remain unconscious for days, weeks, or months.
“It was a long, difficult period of not — just not knowing whether he was going to come back to the Frank we knew and loved,” explained Leslie Cutitta. “It was very, very tough.”
Why? Doctors Just Don’t Know
It’s human nature to want answers, especially in the medical field. Which leaves doctors all the more frustrated and troubled that they can’t determine what is causing the trend of “prolonged” or “persistent” coma.
“Because this disease is so new and because there are so many unanswered questions about COVID-19, we currently do not have reliable tools to predict how long it will take any individual patient to recover consciousness,” said Dr. Brian Edlow, a critical care neurologist at Mass General.
Some experts have developed theories, though nothing is proven. One theory suggests that, compared to other respiratory diseases that cause pneumonia, COVID-19 patients need larger doses of sedatives while on a ventilator, and they’re often intubated for a longer period of time. At the same time, the virus’s effects on the lungs limit oxygen levels, potentially causing inflammation and damage in the brain.
“So there are many potential contributing factors,” Edlow explained. “The degree to which each of those factors is playing a role in any given patient is still something we’re trying to understand.
The Choice to Continue or End Life Support
Given these many variables, doctors are struggling to advise families desperately seeking answers about loved ones who remain unresponsive for weeks after extubation from a ventilator.
Leslie Cutitta was forced to tackle these difficult end-of-life discussions herself as Frank’s unresponsive condition continued. Even without a ventilator, Frank still relied upon a feeding tube, IV fluids, catheters, and oxygen to stay alive.
As one point, a doctor asked Leslie, “If it looks like Frank’s not going to return mentally, and he’s going to be hooked up to a dialysis machine for the rest of his life in a long-term care facility, is that something that you and he could live with?”
When faced with this choice, some family members opt to stop life support measures. Others continue fighting. For Lesli Cutitta, the choice to continue fighting paid off. Frank awoke after two weeks in a coma that doctors couldn’t explain. After another week, he could speak. It took a month of rehabilitation and ongoing physical therapy, but Frank is nearly back to feeling like himself again.