Home again, gratefully

Home again, gratefully

The covid illness and recovery of Bergenfield’s Michael Goldsmith

Joey and Sophie Goldsmith welcome their father home. (Abbie Sophia)
Joey and Sophie Goldsmith welcome their father home. (Abbie Sophia)

Michael Goldsmith is at home in Bergenfield.

The 34-year-old is sheltering in place with his wife, Elana, and their two small children.

Nothing new there, right? Nothing unusual.

Except that Michael, despite a lack of preconditions, despite his youth, despite everything that seems to have made sense, almost died of covid-19. He was on a ventilator in Hackensack University Medical Center from March 20 to April 11. As he lay in the medically induced coma that ventilation demands, his family fought as hard as it could to get him Remsividir, the drug that had been touted as one of a few miracle cures and unlike most of them actually does show some promise.

He never got the drug, but nonetheless he recovered.

Here’s his story.

First, keep in mind that covid first was diagnosed in New Rochelle on March 2; Lawrence Garbuz, the lawyer who had that first case, is a member of the Orthodox community there. Because it’s a tight-knit community, the disease spread rapidly; because the Jewish community across the entire tristate area is closely connected, it spread on both sides of the Hudson long before people understood what it was or how to combat it.

Elana Goldsmith teaches at the Yavneh Academy in Paramus, “and there is a lot of crossover between New Rochelle, Yavneh, and Frisch,” the large Orthodox high school in Paramus. Michael is an IT auditor for Israel Discount Bank; he already was working from home.

“Around March 11, Michael started experiencing fever and a cough, and he was a little dehydrated” Elana said. “It seems like a million years ago! That was when we were hearing that coronavirus might be more prevalent in the area, and that we should be on the lookout for various symptoms.”

Michael and Elana Goldsmith (Abbie Sophia)

“It was two weeks before the shutdown here, and one week before our schools shut down. We were hearing that coronavirus might be coming closer.

“Michael’s doctor told him to go to the hospital, so he went to Hackensack Medical Center on March 13. Because he had two symptoms, and they weren’t getting any better, they admitted him. They tested him for everything — flu, pneumonia, strep, everything — and everything came back negative. Then they tested him for corona. Those results took a couple of days to come back.

“He was still in the hospital on March 15, but they told him that everything looked good — his chest x-ray was clear, and most likely he didn’t have the virus, so he should just go home and ride it out at home.

“They discharged him, he came home late on Sunday, at 4, 4:30ish, and about 20 minutes after he got home he got a phone call from Hackensack.”

The test was positive.

“But they said that given your age, you should continue to ride it out at home.”

So Michael moved to the basement, where he self-quarantined. Elana and the children — their 9-year-old son, Joey, and their 6-year-old daughter, Sophie,  — stayed upstairs, also self-quarantining, because of their proximity to Michael, but under less stringent rules.

Michael’s family and friends came out — and each family group stayed socially distant — to welcome him home. (Abbie Sophia)

“We were quarantining at home; I was trying to home teach and home school, and Michael was downstairs, first staying the same and then getting slightly worse. By Wednesday night, he had a fever of 105. That fever never broke.

“So I called our general practitioner, Dr. Jerome Katz, who telemedicined with him.”

Michael had other symptoms now, to accompany the fever; “he was getting extremely winded very easily,” Elana said. Now we know that such fatigue is a sign of possible covid infection, but we didn’t know it then.

“The doctor said to try to find a pulse oximeter,” a small noninvasive device that measures oxygen saturation levels. They’re now hard to find, but because their son is asthmatic the Goldsmiths happened to have one. “I tested him and his oxygen was very low, so our doctor said that we should call the hospital and tell them that you have to bring him back in.”

That sounds straightforward enough, doesn’t it? But it’s not so easy, when you’re all quarantined, and your children are 6 and 9. “I drove him back to the hospital that night,” Elana said. “He walked himself into the emergency room. They knew we were coming, and there were people around the car, hospital workers, but everyone had to back away. He had to walk himself into the ER.

“That was the last time I saw him for 32 days.”

Meanwhile, neighbors stood watch outside her house, close enough to hear the kids if they yelled for help but not close enough to be infected by them; it was a good solution to a hard problem in this imperfect world.

That night, Wednesday, March 18, the doctors “tried several ways to get Michael more oxygen,” Elana said. Nothing worked, so the next day he was admitted to the ICU, “and they started talking to us about possibly intubating him.” “Us,” at that point, were Elana and Michael. “Michael did not want it. He was very concerned about it, but I told him that if the doctors say it’s the best thing to do, we should do it.”

He was intubated on Friday, March 20. “We were joking about it,” Elana said. “I said, ‘See you in a couple of days. Have a great Shabbes nap.’”

Michael hugged his daughter Sophie, as Elana and his son Joey looked on. (Abbie Sophia)

When he was intubated, “Michael’s doctors told me that there was a very experimental drug, Remdesivir, that was made by Gilead. They said that we could apply for compassionate use for it, given his age and situation. You had to be intubated to apply for it. It made me feel a little better about him being intubated. Maybe he could get this new, exciting drug.”

This is when the story started running in two channels — the story of Michael’s illness, the danger he was in, and the fact that eventually he came out of that danger. The other story is the family’s fruitless fight for Remdesivir, which might have helped him out of danger sooner, and which, the family felt, had been dangled cruelly in front of him.

“On March 21, the doctor said that Gilead had denied Michael compassionate use,” Elana said. “The reason they gave was that they had changed the guidelines, and now only included pregnant women and children under 18.” Clearly he did not qualify. But “we could apply for a clinical trial.

“At this point Hackensack did not have a clinical trial for this drug. Mount Sinai did.” Elana and Michael’s doctors tried to get Gilead to relent, to enroll Michael in a trial, but the company did not relent.

Hugging son Joey. (Abbie Sophia)

So Elana went public. She posted pleas for help on Facebook, and many people, including politicians, responded. “Josh Gottheimer,” the Democratic Congressional representative from New Jersey’s Fifth District, “was extremely helpful.” So was Cory Booker’s office; Mr. Booker, a Democrat, is the state’s junior senator.

“By the Wednesday of the next week, March 25, Gilead finally came back to Michael’s doctors and said that he would be included in the clinical trials, which were starting the next day.”

The family felt hope. The drug was experimental, but it was well worth trying, they felt. Not much else seemed to be working.

“The doctors said that they’d sent over the paperwork late that day. At about 3, 4 o’clock the doctors called, a major conference call, and told me that in order to be included in the clinical trial you could have been intubated for four days or less. Michael had been intubated for six days at this point.

“At first, we thought it was a mistake. They knew about Michael’s case.” She and the doctors called Gilead and asked for a variance; so much time had been wasted in unnecessary back and forth. Gilead’s doctors were immovable. No variance.

They went up the chain of command at Gilead until they reached Diana Brainard, who is the company’s senior vice president. “Michael’s doctors called and begged, and she asked for 24 hours to come up with an answer.

“So another 24 hours went by, and then Diana Brainard called and said that they would not include Michael in the trial.

“It was bad.

“It was very bad. It was bad knowing that there was potentially a life-saving medication that they would not give him. At that point, I didn’t want to give up, so I reached out, asking for help. I asked if anybody had any contacts with Gilead.” Mr. Gottheimer was particularly energetic in his attempts to help, Elana said.

Meanwhile, back in the covid ward, still intubated, “Michael was staying the same,” Elana said. “He wasn’t getting any worse, but he also wasn’t getting any better.” To be more specific, he would get better in the morning and then get worse at night. The days stretched on. Nothing much changed. “They were doing this thing called ‘proning’” — lying a patient down prone, on his stomach, an entirely low-tech way to help him breathe; it’s a technique that’s proving helpful with covid sufferers. “He developed a blood clot, which we know is common among covid patients. It was in his leg, so they could give him a blood thinner for it.

“His doctors were amazing,” Elana said; she said it more than once, with much enthusiasm. “They were quick to spot issues and find ways to solve them.

Michael was on hydroxychloroquine and azithromycin, anti-malarial medications that President Trump had touted, early in the pandemic, as cures for covid; for Michael, as for most people, as the CDC later found, those drugs did nothing. (They cause heart problems in other patients.)

“By April 4, we weren’t losing hope, but he wasn’t getting any better,” Elana said. “The doctors by then were at the what-the-hell point. They decided to give him a drug called Actemra, made by Roche. We’d heard about this drug before, when we were trying to get him on Remdesivir, but then his doctors didn’t think it would be necessary.

“A couple of days before, we found that Gilead had sent out a statement that they would expand their use of Remdesivir and it could go to anyone who wanted it. But Michael’s doctors said that he was too far into the illness.” Remdesivir has been found to have about a 30 percent effectiveness rate at stopping covid’s worst ravages if it is given early enough. It’s not a miracle drug, it turns out, but it has its place in fighting covid.

Elana’s glad that Gilead made that decision, although she’s still angry about the way the company played with her and then rejected her husband. “We enabled other people to get the drug, even though Michael couldn’t benefit himself,” she said.

Meanwhile, Gilead isn’t explaining itself. It doesn’t have to. Chris Ridley, whose email identifies him or her as “Senior Director, Media Relations,” wrote, in full, in an answer to a question about what happened with Michael Goldsmith: “Thanks for reaching out. We are not able to discuss individual patients. Thank you. Chris.” Ridley did not respond to an email asking for further clarification.

And then something happened with Michael.

“He slowly started to turn,” Elana said. “His numbers started to get a little bit better. He was still on the ventilator; and I was about to make Pesach, and I was not sure how to do it. I was alone with the kids.

“By April 9, his doctors said that he was getting a little bit better. The goal was for him to get to 40 percent on the ventilator — that meant that he would be breathing 60 percent on his own — and then we could talk about possibly weaning him off the drug and the ventilator.”

Soon the doctors began the process of weaning Michael. They kept him on the ventilator but turned it off and watched him closely as his muscles tried to take over the task of breathing that the machine had assumed. It didn’t happen right away, and it was a fairly slow process, but on April 10, “at midday his doctors called, and said that he’d had an acute change.” Until then, his lab work had come back looking good, but now, all of a sudden, it didn’t. His oxygen levels were dropping again, fast.

Michael had an emergency bronchoscopy, and his doctors found a large mucous plug in his lungs. They suctioned it out. “Now we know that this has happened to many covid patients,” Elana said.

Now Michael started to improve. On April 11, he was extubated. “There was a big sigh of relief from me,” Elana said, in what must be a huge understatement.

Elana had been able to FaceTime with Michael a few times, and she and the kids were able to send him video messages. FaceTiming was an entirely one-way procedure; she could see him, but he was in a medically induced coma and could see nothing. “It was for my sanity,” she said. “But the doctors said that he probably could hear my voice, and he said later that he thinks he might remember one of those times.”

When he woke up, Elana said, Michael “was extremely disoriented. He couldn’t speak. He didn’t have speech. They were trying to keep him calm. I sent the doctor a list of bullet points of what I thought he’d want to know, although he couldn’t ask. I told him the kids were okay, no one else in the family was hospitalized, he still has a job, he wasn’t fired, the Yankees did not start playing. I told him things that would reassure him, that would tell him that he would be okay, even though none of this really is okay.”

Elana and the kids are okay, for real; they had to self-quarantine, and “we were told not to bother getting tested, but assume that we are positive. Neither my children nor I had any symptoms, but we have to wait for more reliable antibody tests to know for sure.”

Back at Hackensack, “the next day they moved him from the ICU to the step-down unit. It was a really good feeling. I love the ICU, it has the most amazing doctors and healthcare professionals, but I was happy to say goodbye. And they were happy to say goodbye to us.

“I would call the ICU for updates all the time, and they would tell me many times that we can’t talk now. People are coding. That was a constant thing in the ICU.

“In the step-down unit, Michael started getting physical therapy every day. He was there for a week, and he came home on April 19.”

The family was greeted by socially distant but emotionally entirely present well-wishers — and by broadcast media — as they walked into their house that Sunday. “Michael is doing good, but he’s still very weak,” Elana said. “He is getting therapy every day.” And that’s real therapy, not virtual; “we found excellent therapists who come into the house. They are awesome. He is getting stronger every day. There are residual issues that are coming up now, that we could not have known about or prevented, but given where we were when he came home, we are very very lucky.

“This is an incredible miracle, and it puts everything into perspective. We are not taking anything for granted.”

Michael was very lucky in the team he had fighting for him. He had his doctors, his nurses, and everyone else at Hackensack. He had Elana and the rest of his family. And crucially, he had his father-in-law, Dr. Jack Stroh of East Brunswick. Dr. Stroh, at interventional cardiologist at Robert Wood Johnson University Hospital, who “led Michael’s entire campaign,” Elana said. “He was up every night, all night long, working on who to talk to, who to find to talk to someone else, talking to every family member and friend who had contacts. He was doing everything he could,” both to learn everything possible about covid in general and to try to learn about possible drugs, including the ones from Gilead in particular.

It was an interesting change in perspective, Dr. Stroh said. “This is out of my field.” Not only does he not usually work with infectious diseases in the ICU, “Usually I am on the caring side, as opposed to the praying side.

“Usually I am hands-on. When there is an emergency, if someone is having a heart attack, if someone is in the cardiac cath lab, I am the active participant. Here, due to the coronavirus and the restrictions, where even family members can’t go to the bedside, it is entirely out of your hands.

“If you have a loved one in the hospital, there is nothing you can do about it. So the family becomes totally dependent on when the healthcare providers have a few minutes and can call the families instead of taking care of the patients.” And given all the protective gear health care workers must put on, “taking care of the patients now takes more time as well.

“In normal times, if a patient is sick their spouse can be with them and hold their hand,” Dr. Stroh continued. “Here, we went days, even weeks, without seeing him. Here is your loved one in extremis, and you can’t be there.”

It’s not only covid — respiratory illnesses tend to go up and down, Dr. Stroh said. “They are the ones on roller coasters. I told Elana that you pray for two steps forward and one step back, not the other way around.”

Covid seems to have “two separate phases,” he said. “There is the virus multiplication phase, and the body’s inflammatory response to it. Some of the experimental medications being tried now focus on the first, and some focus on the second.” Remdesivir focuses on the first phase; by the time Michael would have been permitted to use it, his body had moved to the second one. “At which point, they used another new drug, which, among other things, did help him.

“Nothing about covid is cut and dry. When you have to take care of a patient with covid, you have to take care of the original problem, and then you have to treat all the side problems that begin while the patient is in the ICU. Blood clots, bacterial infections, and other types of things.

“One of the reasons that Michael made it is that his doctors were on top of all those secondary issues that can come up in the ICU.”

Covid also is hard to treat because it is so new that there are no patterns to weave new information into. Every new piece of data has the opportunity to upend the received wisdom of the day before. “The way the doctors treated Michael at the start and at the end changed,” Dr. Stroh said. “The problem was that the information coming out of China wasn’t always the most reliable. I think that more reliable information came out of Italy and England and other western countries, which were a little more honest and forthcoming about what they’d learned.

“We learned about proning from Europe. Michael’s doctors were administering that to him as soon as he got to the ICU. Every time he got worse they would turn him over, and that would really help.

“Medical information was coming to us in real time day by day.

“As healthcare professionals, we are not used to discoveries coming as they did 100, 200 years ago,” he continued. “This is something new to the human race, and it is so fast-moving, so widespread, that it is scary. We doctors are scared for ourselves, and even more for our patients. We don’t understand why some patients improve and some don’t.

“I read a story about a 104-year-old patient in Israel who recovered, and then about 20- and 30-year-olds who don’t. It seems quite random.

“But you try everything you can on every patient, to give them a chance to recover.”

Dr. Stroh is grateful to the people at Hackensack. “They did an amazing job,” he said. “They touched base with Elana and kept her informed, and somehow, with the help of God, they saved Michael.”