In the fall of 2022, Dr. William Dugal, then 32, contracted COVID-19 and began experiencing unusual symptoms.
“It started with numbness in my feet, almost like my shoes were too tight, and it progressed to the point where I was having trouble walking,” Dugal, now 34, said. from Winston-Salem, North Carolina, to TODAY.com. “I knew there was something seriously wrong.
Dugal, who had just finished his surgical residency, went to a local hospital, where he learned he had a rare post-viral complication called Guillain-Barré syndrome. It can cause muscle weakness to complete paralysis, and very few interventions can slow its progression.
Soon, Dugal became completely paralyzed and could no longer swallow or breathe without assistance. But he could still think clearly.
“I couldn’t even move my eyes or blink. And as this is happening, I can’t express enough the fear and uncertainty that I had,” Dugal says. “Sometimes medical knowledge is a good thing and a bad thing because you are fully aware of the seriousness of your illness. »
COVID-19 infection causes numbness and ‘strange’ symptoms
During Labor Day weekend 2022, Dugal and her family had a lot to celebrate. He had just finished his four-year surgical residency and was preparing to start a new job in North Carolina. His wife had also recently given birth to a beautiful baby girl.
“Things were looking really good,” he said. “(We) were about to start the next chapter.”
They attended a wedding and, after returning home, all three tested positive for COVID-19. Dugal’s wife and daughter had mild cases, but his symptoms were “strange,” like numbness in his feet, Dugal recalled.
Over the next few days, the numbness got worse, so he asked his wife to take him to the hospital. “I had to be carried because I couldn’t walk at all,” he said.
A neurologist ordered a lumbar puncture, which helped doctors quickly diagnose Dugal with Guillain-Barré syndrome, a rare condition in which the immune system attacks the layer around the nerves (myelin), causing nerve damage, according to the National Institute of Neurological Disorders and Stroke. .
“Unfortunately, my symptoms progressed over a month in the hospital, with complication after complication,” he says.
How Guillain-Barré syndrome develops
In mild cases, Guillain-Barré syndrome only causes muscle weakness. In the most severe cases, it progresses to complete paralysis and patients require ventilation to breathe. The duration of the illness can also vary, says Dugal.
Most people recover completely or subsequently experience only minor symptoms, such as numbness or tingling, according to the Mayo Clinic. But recovery can take months or even years. For people who lose the ability to walk, it usually returns within six months.
The disease can also be fatal, especially if the paralysis spreads to the muscles used for breathing. And “sometimes the nerves…are damaged to a point where they are unable to recover,” Dugal says. In these cases, patients remain paralyzed.
The more severe the initial symptoms, the higher the risk of long-term complications, according to the Mayo Clinic.
Experts still don’t know why some people develop Guillain-Barré syndrome, but it most often occurs after bacterial or viral infections. There is no cure or definitive treatment, so doctors usually offer supportive measures, such as ventilation and feeding tubes, Dugal says.
“You don’t know how bad it’s going to get and you don’t know how long it’s going to last,” Dugal recalled of his experience. “It was two types of anxiety for me.”
Ventilation leads to near-death experience
After receiving the diagnosis in hospital, Dugal felt “very aware” of the severity of his Guillain-Barré syndrome.
“I knew that once the problem reached my diaphragm, I wouldn’t be able to breathe,” he says. “It was a humbling feeling to realize that you are at the mercy of the process and you have to accept whatever happens.”
Little by little, he experienced such muscular weakness that he could no longer speak. He remembers trying to concentrate his muscles so he could breathe on his own, but “after a few days I couldn’t do it,” Dugal says.
Doctors put him on a ventilator to help him breathe. At the time, Dugal feared he would never recover.
“I made peace with the thought that I was probably going to die,” he says. “I looked at (my wife) and told her to take care of our daughter.”
There were times, however, when Dugal’s medical training took over. After losing the ability to speak, he blinked to communicate and repeatedly tried to manage his own treatment.
“I was trying to spell out the different ventilation modes,” he says with a laugh. “I actively participated in my care.”
After two weeks on a ventilator, Dugal developed pneumonia – a common side effect of a prolonged period on a ventilator – and both of his lungs collapsed. His oxygen levels became dangerously low and his brain was not receiving enough oxygen, which can be fatal if not treated quickly.
He started coding and doctors put him on ECMO, a machine that supports heart and lung functions to give them time to recover. After nine days, he woke up.
“I was completely there, cognitively, in understanding,” he remembers. “I had these big plastic tubes that all my blood flowed into, and I was completely dependent on how that system worked. You can imagine my anxiety was through the roof.
ECMO had allowed his lungs to heal, however, so he was weaned off and put back on a ventilator. Always, he couldn’t speak, move his fingers or toes, or even blink his eyes. But he knew exactly what was happening.
“Your muscles are so weak,” he said. “I was completely trapped in my own body and sitting there, looking at the same spot on the wall.”
Dugal began to wonder what life would be like. Would he ever be strong enough to return to work as a surgeon?
As his condition no longer worsened, doctors recommended inpatient rehabilitation, but Dugal’s family struggled to find a facility that would care for him while he was still on a ventilator. Eventually, TIRR Memorial Hermann in Houston accepted him, so he took an air ambulance. Once there, he started working on learning everything again.
Two months in inpatient rehab
Rehabilitation seemed difficult. He had lost 60 pounds and was still tube fed because he was too weak to swallow. He couldn’t sit up on his own or get out of bed, so they used elevators to transport him. Good days often included incremental changes so slight they could be hard to see.
“It was little things that would be like trying to straighten your hands… because your muscles are literally not strong enough to open,” he says. “I remember the first time I could wiggle my big toe. …It was the least exciting thing you had ever seen.
Despite the challenges, in rehab, Dugal felt like he could “take control of the situation” for the first time since becoming ill. “(At first) you’re in survival mode and you’re trying to get to the next hour,” he says. “(The rehabilitation) was very slow, but there was progress. »
After two months of hospital rehabilitation, Dugal returned home. He used an electric wheelchair and still required extensive physical, occupational, and speech therapy at home to relearn daily tasks.
“I was trying to get my life skills back,” Dugal says. “Being able to dress myself, eat alone… tie (my) shoes, pick up things.”
Over time, he built his strength to the point where returning to work seemed possible. Nine months after being diagnosed with Guillain-Barré syndrome, he could walk again.
Working as a doctor again meant he had to practice his surgical skills. His wife founded a company, Osso VR, which offered surgical training programs using VR headsets.
“You could kind of do surgeries that look like an operating room and go through the steps of the operation,” Dugal says. “It was a way of bridging the gap of physical limitations, but also trying to get back to that (surgeon) mindset.”
From patient to doctor
In July 2023, almost a year after contracting COVID-19, Dugal felt strong enough to work. He began working in a lab where surgical studies were being conducted, “trying to figure out how to be a surgeon again,” Dugal says.
Then he began an ECMO fellowship, where, for almost a year, he “put patients through the same treatment that saved me in the same hospital.” It felt like things had come full circle.
“It was great to be able to work with the same people who saved me: therapists and surgeons,” he says. “I’m very grateful to be able to operate.”
When Dugal completes his ECMO internship, he will begin a general surgery internship.
Guillain-Barré syndrome changed his perspective as a doctor.
“I have more empathy and a better understanding of the patient experience,” he says. “I hope I can offer the same compassion and support to others in similar situations.”
Being able to care for others who need ECMO after saving him has been an honor for Dugal.
“It’s been very rewarding to do ECMO,” he says. “What I want to continue in my practice is having frank conversations, but also exploring all options to provide hope. »