Emergency room doctor, near death with coronavirus, saved after experimental treatment
急診室的醫生，由於感染了冠狀病毒而瀕臨死亡，經過實驗治療後獲救
Richard Read 理查德·讀
LA Times 《洛杉磯時報》April 14, 2020, 1:48 PM GMT+82020年4月14日下午1:48 GMT+8
Dr. Ryan Padgett, a Seattle emergency room physician, contracted COVID-19 and was saved by doctors who used an experimental treatment. 西雅圖急診室醫生瑞安·帕吉特(Ryan Padgett)感染了COVID-19，接受實驗性治療的醫生挽救了他的生命。(Karen Ducey / For the Times) (凱倫·杜西/《泰晤士報》)
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As critically ill, elderly patients streamed into his emergency room outside Seattle, Dr. Ryan Padgett quickly came to understand how deadly COVID-19 could be.
瑞安·帕吉特醫生(Dr. Ryan Padgett)很快就明白了covid19有多致命。
Of the first two dozen or so he saw, not a single one survived.
在他看到的前二十多隻中，沒有一隻倖存下來。
It took longer for Padgett and his colleagues at EvergreenHealth Medical Center — the first hospital in the country to treat multiple coronavirus patients — to learn how easily the disease could spread.
帕吉特和他在美國第一家治療多種冠狀病毒的醫院——常綠健康醫療中心的同事們花了更長的時間來了解這種疾病傳播的容易程度。
At first, the medical workers wore only surgical masks and gloves. Later, they were told to wear respirators and other gear, but the equipment was unfamiliar and Padgett couldn't be certain he put it on and took it off correctly each time.
起初，醫護人員只戴著醫用口罩和手套。後來，他們被告知要戴上呼吸器和其他裝備，但設備並不熟悉，帕吉特不能確定每次都能正確地戴上和取下。
A 6-foot-3, 250-pound former football star who played for Northwestern in the 1996 Rose Bowl, he wasn't fazed by much.
他身高6英尺3英寸，體重250磅，曾是1996年西北大學玫瑰杯橄欖球隊的球星。
“To worry about myself, as a 44-year-old healthy man, didn’t even cross my mind,” he said in an interview Monday.
“作為一個44歲的健康人，我甚至沒有想過要擔心自己，”他在週一的一次採訪中說。
But on March 12, with his wedding day two months away, Padgett became the patient.
但在3月12日，離他的婚禮還有兩個月，帕吉特成了病人。
Soon after being admitted to his own hospital with a fever, cough and difficulty breathing, he was placed on a ventilator. Five days after that, his lungs and kidneys were failing, his heart was in trouble, and doctors figured he had a day or so to live.
在因發燒、咳嗽和呼吸困難而住進自己的醫院後不久，他就被放在了呼吸機上。五天後，他的肺和腎衰竭了，心臟出了問題，醫生估計他只能活一天左右了。
He owes his survival to an elite team of doctors who tried an experimental treatment pioneered in China and used on the sickest of all COVID-19 patients.
他的存活要歸功於一個精英團隊的醫生，他們嘗試了一種中國首創的實驗性治療方法，並將其用於19位中老年患者中病情最嚴重的一位。
Lessons from his dramatic recovery could help doctors worldwide treat other extremely ill COVID-19 patients.
從他戲劇性的康復中得到的教訓可以幫助世界各地的醫生治療其他19位身患絕症的病人。
"This is a movie-like save, it doesn't happen in the real world often," Padgett said. "I was just a fortunate recipient of people who said, 'We are not done. We are going to go into an experimental realm to try and save your life.'"
帕吉特說:“這是一種電影式的拯救，在現實世界中並不常見。”“我只是一個幸運的接受者，有人說，‘我們還沒有結束。我們將進入一個實驗領域，試圖拯救你的生命。’”
Once his colleagues at EvergreenHealth realized they had run out of options, they called Swedish Medical Center, one of two Seattle hospitals that has a machine known as an ECMO, which replaces the functions of the heart and lungs.
當他在EvergreenHealth的同事們意識到他們已經沒有選擇的時候，他們打電話給了瑞典醫療中心(Swedish Medical Center)，這是西雅圖兩家擁有ECMO機器的醫院之一，ECMO可以替代心臟和肺的功能。
But even after the hospital admitted him, doctors there had to figure out why he was so profoundly sick.
但即使在醫院接收了他之後，那裡的醫生也不得不弄清楚他為什麼病得這麼嚴重。
Based on the astronomical level of inflammation in his body and reports written by Chinese and Italian physicians who had treated the sickest COVID-19 patients, the doctors came to believe that it was not the disease itself killing him but his own immune system.
根據他體內炎症的天文數字，以及中國和意大利醫生對19名病情最嚴重的患者的治療報告，醫生們開始相信，殺死他的不是疾病本身，而是他自己的免疫系統。
It had gone haywire and began to attack itself — a syndrome known as a "cytokine storm."
它已經失控，開始攻擊自己——一種被稱為“細胞因子風暴”的綜合徵。
The immune system normally uses proteins called cytokines as weapons in fighting a disease. For unknown reasons in some COVID-19 patients, the immune system first fails to respond quickly enough and then floods the body with cytokines, destroying blood vessels and filling the lungs with fluid.
免疫系統通常使用一種叫做細胞因子的蛋白質作為對抗疾病的武器。在一些COVID-19患者中，由於未知的原因，免疫系統首先反應不夠迅速，然後向體內大量釋放細胞因子，破壞血管，使肺部充滿液體。
The doctors tried a drug called Actemra, which was designed to treat rheumatoid arthritis but also approved in 2017 to treat cytokine storms in cancer patients.
醫生們嘗試了一種名為Actemra的藥物，該藥物被設計用於治療類風溼性關節炎，但也在2017年被批准用於治療癌症患者的細胞因子風暴。
"Our role was to quiet the storm," said Dr. Samuel Youssef, a cardiac surgeon. "Dr. Padgett was able to clear the virus" once his immune system was back in balance.
“我們的任務是平息風暴，”心臟外科醫生塞繆爾優素福(Samuel Youssef)說。一旦他的免疫系統恢復平衡，帕吉特醫生就能夠清除病毒。
Dr. Matt Hartman, a cardiologist, said that after four days on the immunosuppressive drug, supplemented by high-dose vitamin C and other therapies, the level of oxygen in Padgett's blood improved dramatically. On March 23, doctors were able to take him off life support.
心臟病學家馬特哈特曼(Matt Hartman)博士說，在服用免疫抑制劑、補充高劑量維生素C和其他療法四天後，帕吉特血液中的氧氣水平有了顯著改善。3月23日，醫生讓他停止了呼吸機。
Four days later, they removed his breathing tube. He slowly came out of his sedated coma, at first imagining that he was in the top floor of the Space Needle converted to a COVID ward.
四天後，他們拔掉了他的呼吸管。他慢慢地從昏迷中甦醒過來，一開始還以為自己是在把太空針具轉換成鐵血病房的頂層。
He soon became more conscious of his surroundings and had a FaceTime conversation with family members, who hadn't been able to visit because of the hospital's coronavirus lockdown.
他很快就對周圍的環境有了更多的瞭解，並與家人進行了FaceTime對話。由於醫院的冠狀病毒封鎖，家人無法前來探望。
"It's an incredible thing to survive a brush with death and not be able to see and be with your most loved people," Padgett said. "And when everyone on staff who comes to see you has to be in a spacesuit, you just feel like this pariah. The isolation was pretty devastating at times."
帕吉特說:“在與死神的擦肩而過中倖存下來，卻不能看到你最愛的人，和他們在一起，這是一件不可思議的事情。”“當所有來找你的員工都必須穿著太空服時，你會覺得自己像個賤民。這種孤立有時是毀滅性的。”
On March 31, balloons, gifts and letters came in the door. It was his 45th birthday. "My birthday cake was an ice chip," he said, recalling how grateful he was for his first sustenance by mouth.
3月31日，氣球、禮物和信件進入了家門。那天是他45歲生日。“我的生日蛋糕是一塊冰屑，”他說，回憶起自己第一次吃到食物時的感激之情。
As Padgett got to know Youssef, Hartman and other team members, they told him about a 33-year-old woman — a mother of three — who was in the hospital as well, also having experienced a cytokine storm. He saw the team's excitement when they tried the approach on her, and she too recovered.
當帕吉特瞭解到優素福、哈特曼和其他隊員時，他們告訴他，一名33歲的婦女——三個孩子的母親——也在醫院裡，她也經歷了一場細胞因子風暴。當隊員們試圖接近她時，他看到了他們的興奮，她也恢復了。
Padgett went home on April 5. He said Monday that he faced a long, slow recovery, physically and cognitively. He expects to be a better doctor, reminded how devastating an illness can be to a patient and a family.
帕吉特於4月5日回家。他週一說，他的身體和認知都面臨著漫長而緩慢的恢復過程。他希望成為一名更好的醫生，提醒人們疾病對病人和家庭的毀滅性。
Returning to the ER won't be easy, he said. "But that's my home, that's what I do," he said. "I enjoy that everyone-in-the-foxhole mentality."
他說，回到急診室並不容易。“但那是我的家，那是我的工作，”他說。“我喜歡那種每個人都在散兵坑裡的心態。”
And one day before then, Padgett and his fiancee, Connie Kinsley, plan to have a small wedding ceremony with a few friends on their boat moored on a Seattle lake.
前一天，帕吉特和他的未婚妻康尼·金斯利計劃和幾個朋友在西雅圖湖邊的船上舉行一個小型的婚禮。
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