The long journey of COVID

I really shouldn’t complain. I haven’t lost my housing or job. I have plenty of food and toilet paper, and so far, no close friend or family have died from COVID. That said, this pandemic is hard. In fact, it is exhausting.

During the spring and summer, I gave positive COVID results to a number of patients from my home’s safety, thanks to telehealth. But the reality of telling patients how to self-quarantine when six people live in two rooms with one bathroom, or giving resources about food and other basics because the household provider lost a job, or can’t work because s/he is COVID positive, is tough. Tough on the recipient of the advice and tough on me.

This semester I’m teaching first-year medical students how to talk with patients. It is their only non-Zoom class, and we suit up with masks and face shields. They struggle to use the new equipment, a stethoscope, and a blood pressure cuff, with the additional layers of PPE (personal protective equipment). It’s hard to get the stethoscope earbuds in your ears when you have to work around the mask and face shield! This is a tough way to launch a career.

Watching COVID march through the long-term care facility (LTC), where my sister and mother live, has been the greatest challenge. Each had COVID and survived, mother age 90 and Down syndrome sister age 58. But advocating for their basic needs and dignity took my anger and frustration to new levels, not to mention straining my efforts to manage both. I kept reminding myself of the old adage you catch more flies with honey.

At this point, I worry about the emotional trauma they are suffering from social isolation. Neither fully understands, which is heart-wrenching, and digital media is a woefully inadequate replacement for human connection.

My parents kept my sister Fran close during their final years after she was hospitalized or sepsis (blood infection) and nearly died. Now with my dad deceased and my mom’s failing health, living in LTC no longer meets her needs, and with the lockdown, it’s a prison—Fran can’t see her Mom, can’t go out to day activities. Can’t even play Bingo!

With the chronic understaffing, COVID cases in the facility was a matter of time. First it was the staff, essential workers, who posted GoFundMe campaigns to cover their unpaid sick time. Fran was one of the first patients to turn positive, and the facility was poorly prepared. She went without a shower for over a week; her laundry piled up; she wore pajamas several days straight, and missed breakfast a time or two. Many families complained, and the facility improved a bit. We talked to her through her window. Eventually, we moved her out, back into a group home setting. My dad spent his free time helping to start homes for the adult “retarded” dozens of years ago. That setting brings other challenges, but housemates help meet social needs, and client staff ratios are smaller.

My Mom’s journey with COVID was far more difficult. She moved into assisted living 18 months ago due to repeated falls. A day before she was COVID positive, she did a face plant that gave her a black eye and a swollen cheek. The tumble hurt her pride, and at times she was confused. When they moved her to the COVID unit, she had a hard time knowing what personal items to take with her.

She arrived in an unfamiliar room in a hospital gown and a pullup. The first night, it took me many unanswered phone calls to figure out where they moved her. When I finally reached her on the phone, she was tired and confused. “I want to go to bed, but the nurse told me she has 15 patients.”

Unfortunately, true.

I learned she needed a few more items: a picture of Bill, my dad, and her husband for sixty-some years, clothes, her own nightgown, and slippers. I did what my sisters and I had perfected with Fran, wrote emails, followed by calls to administers’ office phones, and if no response, called cell phones. The next day I was told she could not have her own clothes in the unit. Before we had a chance to learn why my sister went out and bought several outfits to get her through. Then they would not accept brand new clothes because they planned to keep COVID patients in hospital gowns and diapers, so laundry was limited to protect staff. Livid, I phoned the CEO on her cell that evening and asked about “respect and dignity for their clients.” I explained that there was no medical reason to do this for patients who were not bed-bound.

The next day Mom was permitted to wear new clothes.

Staff were kind but carried heavy loads. Communication with family was nonexistent. The administration’s examples of incompetence and poor decisions are long and repeated, too numerous to list here. They are glaring examples of the Peter Principle. Granted, COVID has been difficult everywhere, but these folks were out of their league. They were caring for our sister and mother; my mother and others dismissed their omissions because it is a Catholic facility. We are told, “This is our ministry.” My response: the Catholics have been mismanaging for centuries. (i.e., clergy sex abuse)

Quite frankly, it has been one horror after another. My patience and forbearance are at their limits. None of her daughters have seen her or hugged her since March, going on 8 months, even the out of town doctor-daughters who came to town with their own PPE. Only Fran had a short rendezvous in the courtyard when they moved Mom from the COVID unit back to assisted living.

Now with the new COVID wave, Mom faces continued isolation. She is a bit more confused, either a result of brain damage with her falls or neurological manifestations of COVID. Digital communication doesn’t really work for her, and she’s lost her cell phone somewhere in her room. She desperately wants to get her hair cut.

We’ve attempted to work the system with complaints to the Ohio Department of Health, requests for essential visitor status from the Ohio Ombudsman, and a hospice referral because of her steady decline at age 90. (The birthday celebrated during the lockdown, too.)

I know we are not alone. The impact of the lockdown on the elderly in care facilities is well documented.

Patience and forbearance are needed as we struggle to cope and do what needs to be done in our work, in caring for those we love and protecting our own health. May we all find what we need to gird our loins and keep stepping forward through these difficult and uncertain times – there is a long road ahead.

Therese Zink is a family physician and can be reached at her self-titled site, ThereseZink.com.

Image credit: Shutterstock.com

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