In the fall of 2022, Dr. William Dugal, then 32, contracted COVID-19 and began experiencing unusual symptoms.
“At first my feet went numb and it felt like my shoes were too tight and I had trouble walking,” Duggal, now 34, of Winston-Salem, North Carolina, told TODAY.com. “I knew something was seriously wrong.
Fresh from his surgical residency, Dugal went to his local hospital where he learned he had a rare post-viral complication called Guillain-Barré syndrome, which can cause symptoms ranging from muscle weakness to complete paralysis, and there are few interventions that can slow its progression.
Eventually, Dugal became completely paralyzed and was no longer able to swallow or breathe without assistance, but he could still think clearly.
“I couldn’t move my eyes, I couldn’t blink. The fear and anxiety I felt at that moment is indescribable,” Dugal said. “Medical knowledge can be both a good thing and a bad thing, because it brings home to you the seriousness of the disease.”
COVID-19 infection causes paralysis, ‘strange’ symptoms
Labor Day weekend 2022 saw Dugal and his family have a lot to celebrate: he had just finished his fourth year of surgical residency and was getting ready to start a new job in North Carolina, and his wife had also recently given birth to a beautiful daughter.
“Things were going really well,” he said. “We were starting the next chapter.”
The three had attended a wedding and tested positive for COVID-19 when they returned home, and while his wife and daughter only experienced mild symptoms, Dugal recalled his own symptoms being “weird,” including numbness in his legs.
Over the next few days, the numbness worsened, so he asked his wife to take him to hospital. “I couldn’t walk at all, so I was taken away in a wheelchair,” he said.
A neurologist ordered a spinal tap, which enabled doctors to quickly diagnose Dugal with Guillain-Barré syndrome, a rare disease in which the immune system attacks the layer of tissue around the nerves (myelin), causing nerve damage. National Institute of Neurological Disorders and Stroke.
“Unfortunately, during the month I was in hospital, my condition progressed and I developed one complication after another,” he said.
Progression of Guillain-Barré syndrome
In mild cases, Guillain-Barré syndrome only causes muscle weakness. In severe cases, it can progress to complete paralysis and require a ventilator to breathe. The duration of symptoms can also vary, Dugal said.
Most people recover completely or experience only mild symptoms such as numbness or tingling. According to the Mayo ClinicHowever, recovery can take months or years. For people who lose the ability to walk, recovery usually occurs within six months.
The condition can be fatal, especially if the paralysis affects the muscles used for breathing, and “sometimes the nerves are irreparably damaged,” Dugal explains, leaving the patient paralyzed.
According to the Mayo Clinic, the more severe the initial symptoms, the greater the chance of long-term complications.
Experts still don’t know why some people develop Guillain-Barré syndrome, but most cases occur after a bacterial or viral infection. There’s no cure or definitive treatment, so doctors typically provide supportive care, like ventilators and feeding tubes, Dugal explains.
“You never know how bad it’s going to get or how long it’s going to last,” Dugal said of her experience. “For me, there were two kinds of fears.”
Artificial respiration can lead to near-death experiences
After receiving the diagnosis at hospital, Dugal said it became “a realisation” how serious Guillain-Barré syndrome can be.
“I knew that once it reached my diaphragm I would no longer be able to breathe,” he says. “It was a very humbling experience to realize that I was at the mercy of this process and that I had to accept whatever was happening.”
His muscles gradually weakened and he could no longer speak, and he remembers trying to concentrate his muscles so he could breathe on his own, but “after a few days it just didn’t work,” Dugal said.
Doctors put him on a ventilator to help him breathe, and at the time, Dugal feared he would never recover.
“I accepted that I might die,” he says. “I turned to my wife and told her to take care of our daughter.”
But there were moments when Dugal’s medical training came in handy: After losing the ability to speak, he communicated by blinking and made several attempts to administer his own treatment.
“I was trying to explain the different modes of the ventilator,” he says with a laugh. “I was actively involved in my own care.”
After two weeks on the ventilator, Dugal developed pneumonia, a common side effect of being on a ventilator for long periods of time, and both of his lungs collapsed. His oxygen levels dropped dangerously low, and his brain was not getting enough oxygen, which could be fatal if not treated immediately.
He began to go into cardiac arrest, and doctors put him under anesthesia and put him on ECMO, a machine that takes over the functions of the heart and lungs, giving him time to recover. Nine days later, he woke up.
“I had a complete cognitive understanding,” he recalls, “of my blood flowing through these big plastic tubes and being totally dependent on this system to function. You can imagine my anxiety was at an all-time high.”
But with the help of ECMO, his lungs recovered, and he was taken off the machine and put back on the ventilator. He still couldn’t speak, move his fingers or toes, or blink, but he knew exactly what was going on.
“My muscles were weak,” he said. “I was completely locked in my own body, sitting there staring at the same spot on the wall.”
Dugal began to wonder what his life would hold: Would he ever recover enough to return to work as a surgeon?
When his condition stopped worsening, doctors recommended inpatient rehabilitation, but Dugal’s family struggled to find a facility that would accept him on a ventilator. Finally, TIRR Memorial Hermann Hospital in Houston was willing to accept him, and he was transported by helicopter ambulance. Once there, he began working to relearn everything again.
Inpatient rehabilitation for 2 months
Rehabilitation seemed daunting: He’d lost 60 pounds, his ability to swallow had deteriorated so he was still fed through a feeding tube, and he couldn’t sit up on his own or leave his bed, so he used a lift to get around. On his good days, the changes were often gradual, often imperceptible.
“It was something as small as trying to reach out… because the muscles aren’t strong enough to literally open up,” he says. “I remember the first time I was able to move my big toe a little bit… it was the most boring thing I’d ever seen.”
Despite the challenges, during her rehabilitation, Dugal felt “in control” for the first time since she became ill. “[At first]I was in survival mode, just trying to get through the next hour,” she said. “[Rehabilitation]was very slow, but I was making progress.”
After two months of inpatient rehabilitation, Dugal was released from the hospital. He uses a power wheelchair and required extensive at-home physical, occupational and speech therapy to relearn everyday tasks.
“I was trying to regain life skills,” Dugal said, “like getting dressed, eating by myself, tying my shoes, picking up things.”
Over time, he felt strong enough to return to work and, nine months after being diagnosed with Guillain-Barré syndrome, was able to walk again.
Returning to work as a doctor meant he needed to practice his surgical skills, so his wife found a company called Osso VR, which offers surgical training programs using VR headsets.
“I was able to operate and go through the steps of a surgery as if I was in an operating room,” Dugal explains, “and it was a way to bridge the gap of having physical limitations and also get back into the mindset of a surgeon.”
From patient to doctor
In July 2023, about a year after contracting COVID-19, Dugal felt he had recovered enough to work, and he began working in a lab where surgical research was conducted “while trying to figure out how to return as a surgeon,” Dugal said.
He then began an ECMO fellowship and spent nearly a year “in the same hospital, providing the same care to patients that had saved me.” It was a full-circle moment.
“It’s been really nice to be able to work with the same people who helped me – the therapists and surgeons,” he says. “I’m so grateful to be able to operate.”
Once Dugal completes his ECMO fellowship, he plans to begin a general surgery fellowship.
Having Guillain-Barré syndrome changed his perspective as a doctor.
“I now have more empathy and understanding for what patients are going through,” he says, “and hopefully I can offer that same compassion and support to others in similar situations.”
After ECMO saved his life, Dugal feels it’s an honor to be able to care for others who need it.
“Doing ECMO is very rewarding,” he says, “and what I want to continue to do in my practice is not only have those open conversations, but explore all options to give hope.”
This article was originally published on TODAY.com
