The doctors didn’t know what to do.
Audrey, the incapacitated young woman in the ICU, had just celebrated her 29th birthday. She was physically fit and had been in perfect health. Just six months earlier, she had run a marathon with her twin sister, Kelsey. And Audrey had always been health conscious; she worked as a transplant nurse in Denver.
The medical team — nine doctors working in unison with X-ray technicians, phlebotomists and nurses — could not explain why Audrey’s heart was failing.
Audrey and Kelsey Ellis were born on March 17, 1991, in Berkeley, Calif. Audrey was exactly 10 minutes older. They referred to each other as “Wombie,” short for wombmate. The two were inseparable in their youth, and the only time Kelsey recalls fighting with her sister was on one occasion over clothes in middle school.
Although they had gone their separate ways, the twins remained close. And last year on March 13, Audrey flew from Denver to Portland, Ore., so she and Kelsey could celebrate their birthday together. When Kelsey picked her sister up from the airport that evening, Audrey greeted her with a ludicrous, over-the-top wave and then dance-walked over to her sister. “Helloooo!” Audrey howled.
One month earlier, the World Health Organization had given a name — SARS-CoV-2 — to a highly contagious virus that had originated in China and was already ravaging Europe. The same day that Audrey landed in Portland, President Donald Trump declared the coronavirus pandemic a national emergency.
Although the virus was first confirmed in the United States in January 2020, studies later would find that there were sporadic cases on the East and West coasts in December 2019, though there’s no proof of widespread infection until later.
The twins had traveled to California for Thanksgiving, and both had fallen ill in early December, Audrey with what she later described to Kelsey as the worst flu of her life. She developed a fever, chills and a painful cough. Kelsey lost her sense of smell and taste and suffered from severe body aches. Kelsey’s symptoms quickly passed, and Audrey’s fever eventually broke.
The sisters’ symptoms were consistent with the disease COVID-19, Audrey’s doctors later said. But at the time, there wasn’t a test for the coronavirus, and no one in the U.S. was looking for it.
Audrey never fully recovered, but she didn’t have time to be sick. She was in her final weeks of graduate school, so she pushed through the pain. Her efforts paid off — she graduated with honors and received a perfect score on her nursing licensure exam. Other than a cough she couldn’t kick and mild pains in her chest, she felt perfectly healthy.
“Wombies” turn 29
On the morning of March 17, Audrey and Kelsey rang in their birthday with a good cry. Kelsey said it was perfectly normal; they always cried. She was playfully frantic, raving to her sister about how big the following year would be.
“I can’t believe we are going to be in our 30s, we are getting so old!” Kelsey said. Audrey’s response: “You know, growing older is a privilege denied to many.”
To celebrate, Audrey and Kelsey drove to Multnomah Falls, a popular hike just outside of Portland in the Columbia River Gorge National Scenic Area. The water roared as it dropped 620 feet along a sheer cliff in the dense Oregon forest. The sisters sat in the sun and watched the water for a while. Then Kelsey turned to her sister.
“I just remember looking at her and noticing something had shifted in her eyes,” Kelsey said. “Then I noticed that her lips started to turn purple and I was very worried.” She suggested Audrey see a doctor before flying home to Denver later that night, but Audrey seemed hesitant. She didn’t even want to leave the waterfall. “The mist is helping me breathe,” she said.
Kelsey brought her sister to an urgent care center in Portland, which diagnosed pneumonia. Audrey canceled her flight home and Kelsey booked a room for the night to avoid putting her roommates at risk of infection.
“The last day and the last night that we spent together was our 29th birthday,” Kelsey said. “We had cake. We always liked to blow out our candles together and make a wish, so that was what we did.”
The following morning, March 18, Kelsey couldn’t help but second-guess her sister’s diagnosis. She emailed a friend whose husband was an emergency room physician. She explained Audrey’s symptoms: trouble breathing, chest pain, cough, fatigue and bluish lips.
“You need to take her to the emergency room right away,” her friend responded.
Kelsey rushed her sister to the Kaiser Permanente Sunnyside Medical Center in neighboring Clackamas. The drive only took about 20 minutes, but Audrey was fading. “How much further?” she asked repeatedly. The waiting area of the emergency room was empty when the sisters arrived. The hospital had prohibited visitors just one day earlier to protect patients from the coronavirus.
The security guard asked Kelsey to leave after she checked her sister in. As she made her way from the waiting room back to her car in the parking lot, every ounce of her being told her to turn around and be with Audrey. She begged the security guard, “Please, just let me wait with her.” He looked around at the empty waiting room–one young woman sat alone, hunched over in pain––and agreed to let Kelsey stay.
Audrey was in agony. Kelsey rubbed her sister’s back as she cried, doing what she could to reassure her that everything was going to be okay. The hospital staff finally called her name, and Audrey and Kelsey stood up and hugged each other. “I love you, Wombie,” Audrey whispered. She apologized to the staff for the mud on her boots, caked on from their birthday adventures the day before, as she left the waiting room.
“I actually had this sinking feeling in my stomach. I didn’t want to leave the hospital,” Kelsey said. She sat outside in the parking lot for eight hours.
A medical mystery presents itself
Last March little was known about COVID-19, the disease caused by the coronavirus. Patients typically developed an upper respiratory illness, which could progress into a lower respiratory illness causing pneumonia. People either got better or they got very sick and sometimes died.
Audrey was tested for the coronavirus, but her results came back negative.
Dr. Christine Choo, a critical care physician at the Sunnyside Medical Center, said Audrey had no preexisting conditions. They ran tests for autoimmune disorders and cancers; nothing. Audrey had spent several months living and working in Africa the previous fall, so the doctors tested her for everything and anything she could have contracted overseas; nothing.
But the doctors realized Audrey’s condition was significantly worse than anyone had initially thought — her heart was failing. Dr. Lori McMullen, a cardiovascular disease specialist, was called in to take a closer look at Audrey. When McMullen arrived in the emergency room around 4 p.m., she found Audrey sitting in her bed, hunched over and in tears.
“I can’t breathe,” she cried. “I’m scared.” Audrey grabbed McMullen by the hand and gave her a hug as she wept. The doctor listened to Audrey’s story and looked at the data. It was very, very bad.
“When I saw her on [March 18], I hoped she would live, but I knew she probably wouldn’t live through that hospitalization,” McMullen said later.
Since December, Audrey had felt winded and short of breath. She was so young and her body so strong that she was unaware that fluid had built up around her lungs and heart. McMullen suspects Audrey had developed pulmonary veno-occlusive disease (PVOD). The disease is incredibly rare, so much so that the cardiologists at the hospital had never seen it before, McMullen said.
PVOD, McMullen explained, acts as an impediment, a bottleneck situation in the body. When Audrey was sick in December, McMullen concluded, her lungs built up scar tissue that restricted blood flow in the lungs and resulted in pulmonary hypertension — high blood pressure.
The restricted blood flow put additional stress on the right side of the heart, which pumps oxygen-poor blood from the body into the lungs. To keep up with the body’s need for oxygen, Audrey’s heart worked overtime, all day every day, for approximately three months.
In younger patients, the body can overcome and work through these ailments, at least for a while. “Their bodies can compensate very well for a very long amount of time and they can hide bad things brewing in their body,” McMullen explained. “When they finally do come in … they’re at that breaking point.”
“She’s not out of the woods”
Kelsey waited in the parking lot, unaware of the severity of her sister’s condition. She thought Audrey would be released before the end of the day and had hoped to avoid making two trips to the hospital. Instead, Audrey texted her sister, instructing her to go back to her room for the night. They were moving her to the intensive care unit. She would not be leaving any time soon.
The twin’s mother Janine landed in Portland just after 9 that same evening. The gravity of the situation had set in and she instinctively hurried to be there for both of her daughters. Their father Scott wanted to be there as well, but the couple ultimately decided someone should hold down things at home in the Bay Area. Audrey, they assumed, would be sent home soon, a few days spent recovering at the hospital at most. Someone needed to ensure the house was ready for her return and pick the family up from the airport.
The following morning, Kelsey joined her mother in downtown Portland, about half an hour’s drive from the hospital. Janine would have bunked with Kelsey, but it wasn’t clear whether it was safe to do so. Instead, she booked a room in the city and Kelsey wore a mask when they greeted each other outside.
One of the doctors reached out to give Kelsey an update: “She’s not out of the woods.”
The night before had not gone well for Audrey. She told Kelsey how she couldn’t breathe and that it was painful for her to lie down because it caused her lungs to fill up with fluid. Her heart raced to keep up with her body’s demand, which produced more fluid and further compressed the heart.
Kelsey and Janine sent Audrey voice messages so she could listen to words of endearment without feeling obligated to respond, Kelsey said. They also managed several video calls with each other.
