By Herself, But Not Alone
Nov 05, 2020 Katie Sweeney, Photographs: Ted Catanzaro
A patient recovers from COVID-19 symptoms while staying connected to one dedicated doctor
"You have a light fever—99.5."
Carolina Adamo looked up, surprised. It was Friday, March 6, and Adamo had left work early to see Steven Krems, MD, her primary care physician at Cedars-Sinai in Marina del Rey.
For 10 days, she'd had a relentless sore throat, but she'd tested negative for strep. Overall, she felt OK. She was not expecting to hear the words Krems spoke: She could have COVID-19.
"What stood out for me was how brave she was. She was on her own."
-Steven Krems, MD
That was scary news, but Adamo, 43, had another problem. Her family lives in Italy—the then-global epicenter of the pandemic—and her boyfriend lives in Indiana.
"I am stuck in my apartment," she realized. "I am alone."
Coming To America
Adamo is no stranger to overcoming big challenges.
"I definitely define myself really strong," she says, talking via Zoom from her Marina del Rey apartment. She leans close over the screen, her long, tousled black hair falling forward. Her dark eyes are open wide. "If I was not strong, I do not think I would be here."
Born in Pompei, Italy, she grew up along southern Italy’s breathtaking Amalfi Coast. In school, she loved math and, at home, she peppered her parents and her many aunts and uncles with endless "why" questions.
"I had to have an explanation for everything. Like, why the plane fly? Why the boat floating?" she says, her English adorned with an Italian accent as she waves her arms in the air. "They say, oh, that’s how it’s supposed to be. I say, I don’t think so! I wanted an answer."
Those answers, Adamo learned, came through physics, and she dreamed of becoming a scientist. But after her father had a stroke and was unable to work, the family went bankrupt.
Determined to pursue her dream, Adamo took a job to pay her way through college. After graduating magna cum laude with her master’s in physics from the University of Salerno, she headed to Penn State University in 2006 for her PhD. She had never been to the U.S. She spoke Italian, French and a little Spanish.
"My English was zero, OK?" she says, letting out a long laugh and waving her arms again. "Zero!"
At Penn State, Adamo spent every night memorizing the words in her English-Italian dictionary—starting with A and going to Z—and watching movies with her American roommates. In five months, she was speaking English with relative ease.
By 2012, she was at Stanford University, establishing a research lab related to superconductor materials. In late 2018, she started working as a material science engineer and manager in Los Angeles.
Adamo chose an apartment in Marina del Rey, eager to be near the beach again. Weekends were spent riding her bike to Manhattan Beach and hosting get-togethers with friends, cooking them pizza and pasta from scratch.
Her boyfriend, a professor at Purdue University, spends half the year with her in California. He was supposed to spend spring and summer 2020 with her. But as Adamo left her appointment on March 6, she knew she couldn’t see him. She couldn’t see anyone at all.
While physical distancing guidelines keep Carolina Adamo from cooking big meals for friends, she Zooms into virtual dinners, like this meal shared with Angela Messori and Luca Bert.
'Everybody Was Scared'
The next day—Saturday morning—Adamo's phone rang. It was Krems, checking on her.
"How do you feel?" he asked.
"The same," she answered. "I still have this fever."
He called her again that evening, and again on Sunday. Still no improvement.
The days ticked by. Friends delivered groceries. Adamo's anxiety mounted.
Every day, Krems called and texted to check on her, giving her his cell number so she could reach him immediately, if needed.
It was something he was also doing for his other patients who were suspected to have COVID-19. The constant check-ins helped them manage at home, keeping urgent care centers and emergency rooms clear for sicker people. But the calls also gave him—and his patients—peace of mind.
"Normally, I have patients I'll check on, but I'm usually confident they're doing OK," says Krems, an internal medicine physician. "With COVID-19, we knew that sometimes patients would be fine, fine, fine, and then crash. As primary care doctors at Cedars-Sinai, we talked about this: We have to hold people's hands. We were scared, patients were scared, everybody was scared."
Adamo was scared, too. And she was getting worse. She now had a dry, hacking cough and a painful tightness in her chest. Sometimes she would cough for a half hour straight. Another worry: Her blood oxygen levels, measured with her at-home pulse oximeter, were falling from a normal of 99% to as low as 93%. A 92% reading might warrant a trip to the hospital.
Meanwhile, the news from Italy was grim. Her mom had a mild stroke, one of Adamo's friends died from COVID-19 and a cousin was hospitalized with the virus. Still, Adamo kept a positive front, insisting she was fine during daily Skype calls with her family and her boyfriend.
But one night, lying on her living room sofa, her fears welled up. What if she had COVID-19? What if she died—and worse, died alone?
Just then, her phone rang. It was Krems. It was 10 p.m. She started crying.
"Dr. Krems really cares about people," Adamo says. "He said, ‘No matter what happens, I will be with you.' That was really important to me."
A few days later, she received results of a COVID-19 test.
She was negative.
A Strong Bond
It took months for Adamo's cough to subside. Krems called her regularly, eventually sending her to two specialists to ensure she had no other issues. By June, she was much improved, although still coughing occasionally.
Krems believes she had COVID-19.
"It's very likely we didn't have the right window of time for testing and she was tested too long after the onset of her symptoms," he explains.
She is one of countless suspected COVID-19 patients in the U.S. who couldn't get tested at the right time—or will never get tested at all.
Today, Adamo is moving on in her typical strong-willed fashion. She's slowly regaining her strength with one-hour walks on the beach every evening. Meanwhile, she's been working from home and taking an online class in machine learning from Stanford.
She hopes to see her boyfriend soon. And while the pandemic prevents big gatherings with friends, Adamo often has dinner with them via Zoom and continues to cook elaborate Italian meals for herself.
She and Krems do not talk as often these days, but their doctor-patient bond is strong.
"What stood out for me was how brave she was," Krems says. "She was on her own."
She was not, however, alone.
"I want to thank Dr. Krems for helping me," Adamo says. "He was not just a doctor, but a friend."
Expanding Care in the Marina
Cedars-Sinai's Marina del Rey offices are home to eight primary care physicians, including Steven Krems, MD. But local residents are also served by nearby Cedars-Sinai Marina del Rey Hospital, which offers emergency, specialty and surgical services.
This year, Cedars-Sinai is breaking ground on an ambitious project to rebuild Marina del Rey Hospital—replacing it with a new, nine-story, 200,000-square-foot facility. The new hospital, expected to open in 2026, will feature state-of-the-art operating rooms, an expanded emergency department, and enhanced diagnostic and treatment facilities—including catheterization and gastroenterology labs as well as interventional procedure suites. The current hospital will remain open during construction.
"We're making major investments in our resources and our people, so that when patients need the highest-quality specialty care, they won't have to leave our community to get it," says Joanne Laguna-Kennedy, MSN, RN, vice president of Hospital Operations and chief nursing officer at Cedars-Sinai Marina del Rey Hospital.
The Path to Patient Trust
Steven Krems, MD, sees himself as more than a doctor. He's an educator, too.
"A lot of people don't realize that the word 'doctor' comes from the root in Latin of teacher," explains Krems, an internal medicine specialist at Cedars-Sinai's Marina del Rey location.
"I think I build trust with my patients by taking time to explain things. I like to see that light bulb going off, to see patients better understand their illness or medication. That's really cool."
A native Angeleno, he grew up with an outsized dream of playing basketball in the NBA. Although that dream never came true, being an athlete led him to an interest in human physiology and, later, medicine. After graduating from medical school at Tulane University in New Orleans, Krems completed his internal medicine residency at the West Los Angeles Veterans Affairs Medical Center-UCLA joint program.
As fate would have it, he made the NBA after all. He has been the team physician for the Los Angeles Clippers since the 1990s—something he calls "an awesome gig."
Another awesome gig? Being a primary care physician for over 25 years.
"What I like most are the conversations I have with people, the longitudinal care," Krems says. "Over time, as I get to know my patients, I like to call it a friendship."