Road to Recovery

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Finishing the New York City Marathon marked a miraculous comeback from a life-threatening battle with COVID-19 for one of the world’s top transplant surgeons.


MIRACLE MILES Dr. Kato didn’t think he’d return to long distance running when even short walks were difficult to complete.  |  All photos provided by New York-Presbyterian/Columbia Hospital

The early November morning broke cool and clear, a perfect day for the 50th running of the New York City Marathon. Tomoaki Kato, MD, MBA, FACS, stretched with nervous energy among a gaggle of runners gathered at the starting line, a place he had stood seven times before. But this day was different. Much different. That he was preparing to run 26.2 miles through the five boroughs of New York was nothing less than a miracle. Five hours, 38 minutes and 52 seconds later, Dr. Kato would cross the finish line in Central Park, less than 10 miles from New York-Presbyterian/Columbia University Irving Medical Center, where he saves the lives of countless patients as the surgical director of liver and gastrointestinal transplantation — and where he nearly lost his own a year earlier.

Dr. Kato, 56, felt the crisp fall air fill his lungs as the race began, his surprisingly quick pace and adrenaline allowing him to tick off the first several miles in Staten Island with relative ease. He was nearly overcome with joy as he looked around at the sun-splashed towers of the Verrazzano-Narrows Bridge and the funnel of cheering New Yorkers through which he ran. He couldn’t have imagined the scene a year-and-a-half earlier when he tested positive for COVID-19 and spent nine weeks in the hospital at death’s door.

HEADING HOME Hundreds of adoring colleagues cheered Dr. Kato as he was discharged nine weeks after being hospitalized.

Dr. Kato began to have headaches, run a fever and feel sluggish in March 2020. “I thought I had the flu, but struggled with the idea that it might be something worse when severe pain developed across my back,” he says. This was during the first month of the pandemic when not much was known about COVID-19 symptoms that would necessitate treatment. At the time, with PCR tests in short supply and testing controlled by the state department of health, New York-Presbyterian/Columbia instructed its employees to stay home until 48 hours had passed since their symptoms resolved.

Dr. Kato wasn’t overly concerned. He hadn’t experienced respiratory illness and besides, even if he had COVID-19, his overall good health and lack of preexisting conditions didn’t put him in the high-risk category. He resigned himself to resting at home for a few days until he felt better, but when the flu-like symptoms and nagging pain in his back persisted, Dr. Kato checked his oxygen saturation level and saw it had dipped to 93%. The reading — now considered an indication of COVID pneumonia — increased Dr. Kato’s concern that he was suffering from COVID-19, even though he wasn’t in respiratory distress. An infectious disease specialist at New York-Presbyterian/Columbia suggested he come in to get tested for COVID-19. The test was positive — five days after his symptoms began.

Although Dr. Kato was disappointed that he wouldn’t be able to return to work for at least two weeks during New York-Presbyterian/Columbia’s mandated quarantine period, he still didn’t believe he’d develop serious symptoms. That changed one morning when he was overcome with a severe coughing fit in the shower and had trouble breathing. He quickly realized his condition couldn’t be properly treated at home.

Dr. Kato says COVID-19 patients don’t necessarily experience shortness of breath until the big dive at the end. The euphoria of “happy” hypoxia — the phenomenon in which patients with low oxygen saturations do not exhibit respiratory distress — has been to blame for the demise of COVID-19 patients who don’t realize they’re critically ill until they’re admitted to the hospital, when in many cases it’s too late to recover.

“If another day had passed, I might have been in severe respiratory distress and might not have made it to the hospital in time to be treated,” says Dr. Kato. “In retrospect, I wasn’t cautious enough to pick up on the symptoms of severe illness, partly because of my overall good health and the lack of widespread knowledge at that time about the symptoms of COVID pneumonia. I was denying the severity of the situation from the very beginning. It was a really close call.”

On March 25, Dr. Kato was admitted to NewYork-Presbyterian/Columbia’s emergency room, where he was administered oxygen. His colleagues shared their reflections of that trying time with NewYork-Presbyterian’s Health Matters. “We knew Tom was home and not feeling great,” says Craig R. Smith Jr., MD, the medical center’s surgeon-in-chief. “The next thing we know he’s struggling in the ER.”

Dr. Kato’s condition continued to deteriorate. “Overnight it was clear things were progressing in the worst way,” says Marcus Pereira, MD, medical director of the transplant infectious diseases program at NewYork-Presbyterian/Columbia. “When we first laid eyes on him, it was shocking because he looked much sicker than what we anticipated. He was breathing very fast and looked exhausted. By the next morning, his oxygen requirement kept going up.” 

Dr. Kato was transferred to the intensive care unit. The colleagues he worked alongside to save the lives of countless patients were now collaborating to save his. “That was during the peak of the pandemic, when you cried on your way home because there was so much badness going on that we couldn’t stop,” says Joshua Sonett, MD, the medical center’s chief of general thoracic surgery. “Knowing that one of our own was critically ill made it more personal.”

When Dr. Kato was told he would have to be intubated, he still wasn’t overly concerned about his own well-being — perhaps because of the euphoria caused by his hypoxic state — and even texted his good friend Gebhard Wagener, MD, asking him to perform the intubation. “At that moment, my heart sank because it became extraordinarily real that he was so sick,” says Dr. Wagener, director of vascular anesthesia at NewYork-Presbyterian/Columbia.

While he was intubated, Dr. Kato experienced horrific hallucinations and vivid nightmares that haunt him to this day. In some, he was receiving care in frightening hospitals around the world, screaming to his providers to let him go home. He remembers being surrounded by a bright white light. He thought he had died.

Dr. Kato was placed on a ventilator for nine days before his condition deteriorated further. He was teetering on multi-organ failure and nearly died several times. His colleagues and friends huddled in the hallway outside his room, fretting about his chances of survival. As a last resort, they decided to put him on ECMO, an extracorporeal membrane oxygenation machine that pumps blood and oxygen through the body and removes carbon dioxide. His chance of surviving was 10%, according to Dr. Smith.

Dr. Kato had become one of the sickest patients in his own hospital. His physicians discovered he had superimposed bacterial pneumonia — bacteria growing in his bloodstream, which was treated with antibiotics. It was only then that he showed the first signs of what would be a slow and gradual recovery.

About four weeks after being intubated, Dr. Kato began to emerge from his unconsciousness. However, he remained confused and agitated after coming off the ventilator, and concerns grew that he had suffered brain damage. He moved to the hospital’s neurological intensive care unit, where doctors found and treated a minor blood clot in his brain.

Soon after he awoke to sun streaming through the window of his hospital room. Dr. Kato saw the Hudson River below and the George Washington Bridge in the distance. A nurse was sitting by his side. He asked him, “Am I in New York?”

“New York? You’ve always been in New York,” replied the nurse. 

“That’s when things began to make some sense again,” says Dr. Kato.

Still, a long road of recovery lay ahead. Dr. Kato lost about 25 pounds and nearly all his muscle strength. He was on dialysis, had several IVs placed and required a nasogastric tube to receive nutrients.

On April 27, Dr. Kato was transferred to the medical center’s acute rehab unit, where he would begin a grueling regimen to regain his strength. He first learned to hold himself up on handrails before gradually building up the endurance to walk on his own. Finally, a month later, Dr. Kato was ready to go home.

“Kat-to! Ka-to! Ka-to!” The cheers echoed through the lobby of NewYork-Presbyterian as more than 200 of the hospital’s workers surrounded Dr. Kato’s wheelchair as he was discharged on May 26, nine weeks after being admitted. He’s a beloved physician, a kind soul who would do anything for his colleagues and patients. “The hospital celebrates when all COVID patients leave. I knew there would be a celebration, but I didn’t know it would be that big,” says Dr. Kato. “It was an emotional moment, and I truly appreciated everyone who played a part in curing me. I survived because of their hard work.”

It was an emotional moment, and I truly appreciated everyone who played a part in curing me.
— Tomoaki Kato, MD, MBA, FACS

Dr. Kato beat COVID-19 during the first wave of the pandemic, when little was known about how to protect the nation from the spreading virus and the best ways to treat infected patients. “My sickness was a scare for everybody,” says Dr. Kato. “Healthcare providers knew what COVID was, but didn’t fully believe they could be at risk of dying. They faced a constant threat of getting COVID and fought through their fears to do their jobs. To see me get back to normal was a celebration for my journey, and a celebration for everyone else who worked in the hospital.”

As Dr. Kato was being wheeled out of the hospital, he thought about the day he’d walk back in to care for patients. Questions remained about whether he’d regain the physical strength to endure and perform grueling transplant surgeries, which can last for 10 hours. He lacked nerve function in his shoulder, and couldn’t raise his arms as a result, but it eventually returned about a month after his discharge.

After several months of physical therapy, Dr. Kato returned to the OR in August to perform a robotic hernia repair. It’s a relatively straightforward procedure that requires little physical strain. He sat at the console, placed his hands on the controls and began to operate as several colleagues gathered outside the room to watch.

“That was really a moment,” he says. “I was nervous, to be honest, but as soon as I began the case, my skills and coordination came back quickly. It was a big relief.”

Dr. Kato slowly ramped up his workload between September and December, nearly reaching his typical caseload of transplant procedures by the end of the year. When his body could once again endure the rigors of those marathon surgeries, he began to believe he could complete one more comeback.

FINAL LEG Completing the New York City Marathon gave Dr. Kato closure after his grueling rehab.

A journey of a thousand miles, which is what a marathon must have looked like to Dr. Kato, begins with a single step. He pieced 30 of them together during his initial phase of rehab as he walked short distances to build up his leg muscles. He walked every day, gradually extending the distance he could cover before his legs screamed in pain. Jogging was impossible. 

Dr. Kato continued to build his physical endurance, mostly to make standing for long hours during surgery easier, and was eventually able to jog. His jogs turned into slow runs and over several months he was able to complete 3.1 miles — the distance of a 5K race. Dr. Kato’s heart rate remained high during these runs, so he figured the progress he was making was unsustainable. Still, he kept at it.

During the winter months, he received an email invite to enter the lottery entry of the New York City Marathon. He decided to register, figuring he might not be chosen and, if he was, he could always defer the spot if his body wasn’t ready to run in early November. 

His progress on the road continued in the spring and he made a triumphant return to racing at the Harlem 5K Run in August. His pace was slow, but his heart rate remained steady, which gave him hope that he might be able to run the marathon. Dr. Kato continued to build his endurance, but was ready to quit at any time. “That was my strategy,” he laughs.

Dr. Kato did earn a spot in the NYC Marathon and when he completed a 10-mile race in Central Park, he decided to commit his mind and body to running 26.2 miles.

This year’s marathon had a different vibe than the ones Dr. Kato had run in the past — it was a citywide celebration of the recovery from the worst of COVID-19. There were far fewer runners than in years past, allowing the boisterous spectators to crowd the route and shower the runners with constant support. “There were times throughout the race where I was close to tears, because I felt like I was returning to who I used to be,” says. Dr. Kato. 

He got off to a fast pace, too fast perhaps, and slowed after 18 miles. He knew he’d be able to finish the final stretch, but was disappointed that he wouldn’t beat his personal record. “That,” he says, “would have been cool.”

Dr. Kato has been asked why he pushed himself to run the marathon. Wasn’t making it out of the hospital alive and returning to surgery enough? Wasn’t he lucky to return to the profession he loves? “Finishing the marathon was something I was able to do before I was sick and coming back to do it again felt like the closure to my COVID story,” he says. “COVID didn’t defeat me. I’m so grateful that I was able to come all the way back, and so thankful to my colleagues who helped me along the way.”

Patients who need organ transplants often seek treatment from Dr. Kato as a last resort, and he now has a special connection with each one. He lets them know he’s been in their place and understands their fears and uncertainties.

“That’s been a positive,” says Dr. Kato. “The other thing I’ve learned is that you never know what will happen tomorrow, so don’t put off the things you want to accomplish. I’ve realized the importance of every day in your life. That’s something I feel much stronger about now.” OSM

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