Two ends of the Covid Cove

Posted on Feb 1, 2021 in Wellness Committee | 0 comments

Two ends of the Covid Cove

Ms. A was an 85-year-old woman who always clutched her rosary and had a traditional Central American shawl on her bed.  My Spanish is not great, but I understood her prayer when I entered the room.  She had come in the night before with cough, fever and shortness of breath.  She had tested positive about 7 days before – so had all the people in her multigenerational home.  Her o2 sat was 95% on 5l nasal canula, so over the phone, I felt comfortable reassuring both her and family that she would likely do well.  All the time Ms. A said she just wanted to go home.

Down the hall was Mr. D; he was an 81-year-old former Vietnamese “boat person” refugee.  He had experienced cognitive decline and weakness for a couple of years and went into a snf 6 months before the “lockdown.”  He had come in 3 days prior to my coming on service.  While he didn’t talk even with an interpreter, he ate well and had looked comfortable for days on 45% O2.

Each day the hard-working nursing staff on the unit, donned their sweaty blue plastic robes, face shields and N-95s and worked to feed, bathe and provide medicines.   And of course, we all relied upon the RTs who essentially managed the all-important oxygen for us.

Ms A’s o2 needs crept up each day as did her anxiety and the plaintive tenor of her prayers and enquiries about going home.  I got a priest to visit, not for last rites but just for some support.  I backtracked on prognosis with the family. 

4 days into her stay she needed 95% O2 and with that her pO2 was only 70.  I told her family it seemed the virus would likely claim her life shortly.  I said we could see how she did on 60% – that’s the max she could get at home with hospice.  If she did ok with that, she could get home which was clearly her wish.  I called them after 2 hours on 60% to tell them she was up eating and despite a low sat and slight increased resp rate, she looked ok.  “Can you guarantee that she would not make it if she stayed in the hospital? “

“I am sorry, but this is such a new disease, I can’t say that for certain.” I replied.   Feeling bad about it, the opted to have her stay in the hospital.

Down the hall Mr. D had stopped eating.  First it was dinner and now it had been a day and a half without food; also, his sats dropped as did his bp.  A nurse exited his room; despite the mask and steamed up glasses, I could read her body language.  “That poor man is dying.’ She said.  I told her I agreed and called the family with the news and to offer them a chance to visit and to talk about home hospice. 

“He has not seen any of us in 10 months. We would love to visit and talk about bringing him home on hospice.”  The next morning 4 of his 9 kids showed up with a quart of jook, an Asian rice porridge, for him and pastries for the staff.

They left the room smiling an hour later. “He ate all the jook and he smiled!  Yes, let’s work on home with hospice.”  That night he bp was better and we were able to move him to 8 liters oximizer and the staff agreed he looked much better.

The next day Ms. A was less responsive with sats in the 80’s, but still had this great sense of warmth and dignity about her.  Family was able to visit and when I walked in the room, Spanish catholic hymns were playing on a phone, her two children each had hand and, on an iPod, there was a chorus of tears.  20 family members were all crying on a Zoom call.  Together this made the most beautiful soundtrack to an end of life I have ever heard. I tried hard not to join the chorus as we talked about turning off the oxygen to help limit her suffering.

With the help of Sara, the RT and Kamal, the nurse, we added a bolus of morphine to her drip and removed the oxygen.  She looked so much more beautiful and peaceful without it.  Briefly, she closed her eyes then opened them, her breathing calmer.  And with the hymns and the chorus of her crying family, she lived another 20 minutes in the loving presence of her big family.

Meanwhile, down the hall, Mr. D’s family arrived in great spirits armed with more food for patient and staff.  He was to go home later that day with hospice.  When they saw him up in the chair without the oxygen, they said, “It is a miracle Dr Hass!  He is going home on hospice but having beat Covid!  We can’t thank you enough!” 

“Don’t thank me!  He was cured by love and jook!  What a lesson for us all.  Sometimes there is no better medicine than food from home and love!”  All bursting with joy, we shared some “elbow love” and took some pictures before he was wheeled home.

Back at the nurse’s station, there were tears. Sometimes life is so full of emotion that it is hard to give it a name – joy? grief?  Our bodies almost pulsing, our minds searching for words, it is as if an ancient process is marking a time and place in our souls.  “This is what it is to be a human being living with love and creating meaning” the experience seems to be telling us.

All I can say is “Well everybody, thank you all for your efforts. And isn’t this amazing work!”

Leif Hass, MD
Summit Wellness Chair

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