Updated: May 21, 2020
By: Karen Kawaguchi and Lisa Muloma
Dr. Roberto J. Rivero-Soto is a General Surgery Resident at a major medical center in the Bronx, New York City. Originally from Venezuela, Dr. Rivero-Soto moved to the U.S. for college, and he subsequently attended Aureus University School of Medicine in Aruba.
During the pandemic, Dr. Rivero-Soto has been working in a COVID-only ICU, with an average of 25-30 patients, most of them intubated. This ICU unit also received many critically ill patients transferred from other New York City hospitals.
Q: What has been your experience working with COVID-19 patients and your healthcare team?
Most of my patients were intubated and critically ill. Many have died, but some have continued to recover. My hospital just started performing tracheostomies and PEG tubes for COVID patients and we have been able to extubate a good portion of our patients. Some of them have been transferred to rehab facilities.
My experience working with healthcare colleagues has been amazing. I have worked with nurses from all over the country. I have also worked with military doctors, some of whom had just returned from service in other countries.
We heard that you recently recovered from a bout of COVID-19 yourself. How are you feeling now?
I am feeling great, stronger than ever. I am just happy to be back in the hospital caring for patients. Perhaps one of the hardest parts of the course of my COVID-19 was being in isolation and not being able to care for patients during the first two weeks of the pandemic.
Compared to the patients I am currently caring for, my case would be considered mild-to-moderate in severity. I did not require hospitalization, but the amount of chest pain I felt with each cough was tremendous. I had a fever for nine or ten days, averaging 101 degrees during the day and 102-104 at night.
With my fever and chest pain, I realized that I probably had atelectasis (complete or partial collapse of the lung or an area of the lung) that was starting to develop into pneumonia.
Another painful symptom was back pain, which limited my mobility. I also had a sore throat and was very fatigued, but did not lose my sense of smell or ability to taste.
Photo by Ashkan Forouzani via Unsplash
While you were ill, you made your own incentive spirometer at home. First of all what is an incentive spirometer? How do people use it?
The incentive spirometer (IS) is a device commonly used in hospitals to encourage post-surgical patients to take deep breaths. It functions to promote deep inspirations (inhalation of air into the lungs) at a steady rate, which in turn helps keep the alveoli (tiny air sacs in the lungs) open. It helps to prevent atelectasis and its consequences, including pneumonia.
How did you get the idea to make your own incentive spirometer?
After seven days of fever, being unable to take deep breaths or complete my coughs due to severe chest pain, I realized I needed to work on my inspiratory effort. To help me cough and take deep breaths as much as possible, I made my own incentive spirometer (IS) at home
Being a General Surgery Resident helped, since my work in the hospital every day is to provide my post-surgical patients with an IS device, as well as teaching them how to use it.
How did using the incentive spirometer help you recover from COVID?
It significantly improved the clinical course of my COVID-19. As soon as I started using my incentive spirometer, I was taking bigger and deeper breaths, coughing more, and started to excrete a lot of secretions. My fever decreased after 24 hours of use and resolved after 48 hours. My coughing gradually decreased, and I cleared lots of secretions.
One of the main benefits from the daily use of the IS, which is actually very important for the elderly, is that using the device keeps the respiratory muscles active and strong. This results in a decreased chance of getting superimposed pneumonia from not having adequate breathing mechanics.
Photo by Glenn Carstens-Peters via Unsplash
How can people make their own incentive spirometers?
People will need these items and will want to follow these steps:
A clean plastic bottle of water or any type of drink. It is important that the plastic material is semihard, so when you breathe in from the device, the plastic doesn’t collapse.
Mouthpiece. Some bottles have a built-in mouthpiece. I used a small, clean socket as the mouthpiece for my bottle.
A knife or other device to open small holes on the bottom of the bottle. It is important to make six to eight very small holes, approximately 2-3mm in diameter. This maintains a good vacuum effect during inspiration and prevents water rushing from the plastic bag into the bottle too fast. The IS has to allow you to breathe in slowly, with adequate time to open as many alveoli as possible. Also, if the water rushes from the plastic bag into the bottle too fast, you might swallow water.
A Ziploc or other strong plastic bag.
Tape to hold the Ziploc bag to the bottle.
Indications of measurements of water level on the bottle. I put some tape on the side of the bottle, measured the distance in centimeters, and marked the centimeters with a pen.
Water. After the plastic bag is taped to the bottom of the bottle, fill the bag with water through the mouthpiece of the bottle. There should be no water in the bottle before you begin the inspiratory exercise. This helps to prevent water from going into your mouth when you take a deep breath.
When you’re done using the incentive spirometer, drain the water out the bottle and let it air dry. Retape the plastic bag to the bottle, as needed. Put fresh water into the plastic bag through the bottle with each use.
From your experiences on the frontlines, what is an experience or story that you’ll remember for a long time?
I will certainly remember every aspect of this pandemic, not only a single experience of story.
To me the most amazing part has been this: I never thought the practice of medicine would ever become a common single specialty, which I call “COVIDology.” At this point in time, it doesn’t matter how many specialties we have. It doesn’t matter if we are cardiologists, nurses, or neurosurgeons. It doesn’t matter how many papers we have published or how many conferences we have attended. Today we all are frontliners, troopers, doctors.
Today we are the hope for the world. Today, all people put their hopes on us, to heal them, to keep them safe, to protect them, and to give them a future. Today, all doctors are fighting against a devastating and unknown disease that breaks our hearts, breaks our souls, breaks our spirits, but also gives us strength. Behind every mask there are wounds, there are tears, there are sleepless nights, but above all, there’s love, there’s passion, there’s dedication, and there’s a heart full of hope. I will never forget the people I have had the opportunity to work with.