Surviving SARS -- and Living With the Wounds

The disease that overwhelmed Simon Tse, a 41-year-old Hong Kong clergyman, shook his faith in God and filled him with anguish for infecting his wife.

It was the same SARS virus that a few weeks later made its way around the world and ambushed Christel Clark, a 46-year-old emergency room clerk at Toronto’s Scarborough Grace Hospital. One moment she was fine, the next her resting heart rate raced to 134 beats per minute, her temperature rose to 103.7 degrees, and her mind filled with hallucinations of her long-dead mother.

While Tse and Clark were fighting for their lives, Dr. John Charles, a 60-year-old cardiologist working at the same hospital as Clark, shook off the virus quickly. His 100.3-degree fever abated in three days and he was home reading detective novels in six.

“I don’t know why I got off so easily,” Charles said, still puzzled over his brush with the deadly disease.

Three people, three stories -- none quite like the others.

The experiences of Tse, Clark and Charles are a window into one of the mysteries of SARS. The disease strikes some with enormous virulence; in many others, including most of the 63 cases in the U.S., it passes like a severe case of the flu, putting them out of commission for days rather than weeks.

It took just more than two weeks and a plane flight home from Hong Kong for an elderly Toronto couple to spread the disease from Asia to Canada. The chain of human contacts has led to more than 7,000 SARS cases around the world and more than 500 deaths.

Virulent or mild, severe acute respiratory syndrome puts its victims on a physical and emotional roller coaster. Tse, Clark and Charles suffered a profound sense of isolation. They feared they might die. They dreaded spreading the disease to others. And they will long remember the small gestures of friends and colleagues that got them through.

“It’s changed my life,” Tse said. “I know now I need more balance, more time with my family. Less pride, more humility.”

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As a church pastor, it was only natural that Simon Tse visit the territory’s large Prince of Wales Hospital to tend to a patient dying of cancer. It was because of that early March visit that Tse became one of the earliest SARS patients.

There wasn’t even a name for the disease then. It was simply called “atypical pneumonia.”

For Tse, the first sign of trouble was a slight sore throat and muscle ache that came on as he made his way home after his second visit to the cancer patient.

He chalked it up as yet another bout with the flu, which he had already had twice in the last year. His fever persisting, he stayed home the next day and saw on television that several medical workers at the hospital he had visited had been struck by a flu-like illness.

He had a fleeting thought that he might have the same thing, but he dismissed the notion. His doctor didn’t give it much thought either, despite a fever that had climbed to 102 degrees, and sent him home with flu medicine.

His fever escalated to 104 degrees, and the next day he dragged himself to an emergency room, where doctors examined and discharged him after an X-ray failed to show anything amiss.

That night, relentless diarrhea set in, and after two more days of high fever he returned to the same hospital emergency room.

This time, when he informed the attending doctor that he had visited the stricken Prince of Wales Hospital, the doctor made the connection and immediately put him in an isolation ward. The following day, Tse would join other SARS patients at Prince of Wales. He would be in a ward surrounded by about two dozen other victims, many of them the same medical workers he had seen on TV.

The hardest days were still to come.

He learned that his wife, Rosa, 38, had fallen victim to the virus too and lay in an adjacent ward at the same hospital. And a young nurse, after listening to his chest, suggested he might do better in intensive care.

“I began to cry,” Tse said in an interview last week at his church in the thickly populated Mong Kok district.

His spirits hit rock bottom when the patient in the next bed died. The screams of grieving relatives filled the intensive care unit, haunting him.

“There were a few days when I felt I wasn’t going to make it,” he said. “I thought I might die too.”

He was devastated that God didn’t seem to be heeding his calls.

His wavering faith steadied as he recited lines from the 23rd Psalm over and over:

“Though I walk through the valley of the shadow of death, I will fear no evil: for Thou art with me.”

After 12 days, Tse’s fever broke. His spirits soared when he was transferred out of intensive care.

His greatest relief was getting a glimpse of Rosa up and walking around in an adjacent ward -- proof that she too was out of danger.

Today, two months after Tse felt the first hints of illness and five weeks after leaving the hospital, the effects remain. An experimental pharmaceutical cocktail used by Hong Kong doctors to fight SARS has left his immune system weakened and his hands with a slight tremor. His already slight frame is 15 pounds lighter and chest X-rays reveal what doctors call a shadow on his lungs.

The emotional effect is harder to judge.

“We know now how to treasure every minute with our family,” Rosa said. “We’ve learned that life isn’t always under your control.”

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Clark’s first sense of the gravity of her illness came when she heard the fear in her son’s voice. “Mom, are you going to die?” 18-year-old Jon asked when he called his mother’s hospital room. “You sound like you’re dying.”

She could barely respond. “I’m sick and I’m weak, but I’m not going to die,” she recalled saying.

Truth be told, she did think she was dying. She was terrified of dying alone, cut off from seeing her family even one last time, since she was forbidden from having visitors.

What kept her grounded, she said, was a vision of her mother, who had died 29 years ago, urging her to be strong, to hold on, that it wasn’t time to die.

By the time Clark was hospitalized at the end of March, news of the virus’ spread to Toronto had vaulted into headlines around the world.

But she knew little about that. No newspapers were delivered. She had no television to watch because the technicians responsible for connecting it were too scared to come in.

Clark apparently caught the disease a week earlier from a patient who came into Scarborough Grace Hospital’s emergency room. She took his insurance card.

Set to start a new job the following week, she left the hospital for what she thought would be the last time a few days later and spent the weekend in Ottawa with her boyfriend and son. She woke up that Saturday in tears. Every joint ached. She could barely rise from the couch. She thought it was a bad reaction to a drug she had been taking for vertigo.

She managed to drag herself home on a four-hour train ride Sunday night, and the next morning began her new job as a secretary to an obstetrician at another hospital. By the time she got home that night, her temperature had shot to 103.6 degrees.

After another day of suffering, she called the hospital’s occupational health department, which suggested her illness matched the symptoms of SARS. She didn’t believe them and didn’t go to the hospital until the next day.

A special taxi with a masked driver picked her up. X-rays revealed pneumonia in her left lung that would soon spread to the other lung.

The hospital’s isolation wards were full, so an ambulance transferred Clark and three sick nurses to Mount Sinai Hospital, another Toronto facility quarantined for SARS patients.

By then, health officials had quarantined her boyfriend, her son and his girlfriend, and her new boss and his wife.

For 12 of the 17 days she spent in the hospital, she shared a room with one of the nurses from Scarborough who also had SARS. They commiserated, and that took an edge off the loneliness.

News that her relatives and boss had made it through their 10-day quarantine without contracting the disease brought enormous relief. “That would have been awful if I made them sick,” she said.

Clark was sent home to her two-bedroom apartment but wasn’t allowed to be with anyone for nearly three weeks. When friends and relatives came bearing fresh fruit, homemade soups and stews, she buzzed them into her 16-story building. They would deposit their gifts by the closed apartment door and leave. Sometimes, she’d wait a minute until they got to the end of the hall -- far enough so she couldn’t infect them -- to wave hello.

She ached to join the people she could see on the street from her ground-floor window, envious that life had ever been that normal. Occasionally, she managed to laugh, like when she watched “Sister Act” for the umpteenth time, a video delivered by her daughter.

And she tried her hand at poetry:

32 days all alone, the walls are closing in on me.

So sad, I cry more tears than I can ever believe.

The empty long days filled with TV, Internet and phone.

But the lack of a human’s touch chills me through to the bone.

Clark took her first steps outside nearly two weeks ago, when doctors cleared her to reenter the world. She was back in five minutes, completely drained. Her legs are still shaky and she coughs a lot. She weighs 21 pounds less than she did before SARS.

Her doctor says her lungs appear to be permanently scarred and she’ll never have the energy she did.

Bit by bit she is getting stronger. She can make it up the 12 steps from the laundry room. But she still wonders: “What will I be like when I’m 60?”

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It was a 76-year-old heart patient he was treating that passed the disease on to Dr. John Charles, a cardiologist. The man had entered the hospital with an irregular heartbeat but had the misfortune of ending up on a gurney next to the son of the infected returnees from Hong Kong.

A few days after examining the patient’s chest and heart, Charles’ flu-like symptoms came on. His temperature shot up to 100.4 degrees, and the next day he packed a bag and went to the emergency room.

Pneumonia had filled his left lung with fluid. He was admitted to the hospital and put in isolation.

Nearly everything that came into Charles’ room had to be left or thrown out. Food came on paper plates and in plastic cups, disposed specially with other medical waste. Thermometers were tossed out. The blood pressure machine, stethoscope and other equipment stayed in the room for use exclusively by him.

His hospital friends would peer through the glass of his room and wave. For his 60th birthday, four nurses -- covered in masks, gloves and gowns -- delivered a cupcake with a candle in it.

It was the chronic fatigue and shortness of breath that distinguished SARS from any flu Charles had in the past. Though he discusses his disease in a detached and clinical way, Charles admits the diagnosis scared him.

“I knew people were dying in Hong Kong and China,” Charles said.

The disease felled 10 to 15 of his colleagues in the coronary care unit, some with cases far more severe. Still, Charles put SARS into perspective. “More people die in auto accidents,” he said. “Crossing the street is more dangerous.”

To Charles’ relief, within three days, his temperature was back to normal. Six days after his admission to the hospital, he was allowed to go home to his two-bedroom apartment. He was told to have no contact with anyone for a week. He stayed in touch by phone and the Internet and devoured Ed McBain’s “87th Precinct” series of detective novels.

He went back to work, though he was forbidden to have direct patient contact for another week. Some patients canceled appointments when they learned he had been stricken with SARS. He offers to wear a mask at work, but no one has taken him up on the suggestion.

Life at Scarborough Grace Hospital will never be the same, he said. The hospital reopened in late April after being closed for a month. Now, anyone coming into the emergency room is screened in a tent outside the red brick hospital before entering. Temperatures are taken and questionnaires filled out about symptoms and travel to Asia.

“I certainly realize how vulnerable we are, how frail,” he said. “You can be exposed to something as quickly as it takes an airplane to go from one side of the world to the other.”

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Reitman reported from Los Angeles and Marshall from Hong Kong. Times Hong Kong bureau researcher Tammy Wong contributed to this report.