Reflections during a stressful time

The world collectively has been facing the pandemic since 2020 and many have gone through and continue to go through some stressful times because of the virus.

All these months, I thought I was taking as much precaution as I could to keep my elderly parents relatively safe even though I continued to go into work for most of this time. I was focused on business continuity at work, humanitarian response and working on the strategic plan for the next three years and trying to facilitate staff wellbeing initiatives.

August 2021 changed this perspective.

First, my 77 year old father had another return of his cellulitis, which has been a recurring visitor for the past two years and each time before we admitted him to the hospital, they would do the rapid antigen test and only admit him after the result turned out negative. This time, on August 18, our neighbourhood hospital was full so his doctor asked us to bring him to another private hospital that he visited. It was with great difficulty that my brother managed to find an ambulance to take my father to that hospital and there, they immediately did the rapid antigen test. This time though, the result was positive. The hospital immediately turned out my father and brother out of their premises. My father was completely immobile by this time, was confused and unable to speak and this hospital turned him out onto the road. For the next couple of hours, my mother and I tried calling all the private hospitals to check for space to admit an elderly COVID patient with health complications. Every one of them stated that they do not admit COVID patients. They only had interim COVID centers, in partnership with star hotels, that allowed for isolation of the patient in a hotel room. Medical treatment was not provided at these hotels/ interim COVID centers and the patient was expected to be able to fend for themselves. Further, they did not accept elderly patients or any other patients, who needed medical treatment. The ambulance that had dropped my father at the hospital had left and it was another two hours, before we were able to get that ambulance back. It was night time, and curfew time was approaching, and we had no choice but to bring him back home. After a sleepless night, where my mother tried her best to get my father to have something to eat and drink, we decided that it was best to move him to the government hospital that his doctor had suggested, as he was in urgent need of medical attention. So the next morning, my brother took him to the nearest government hospital, admitted him to the COVID ward and returned home. What he found in his subsequent visits to the hospital was that my father was not being treated for cellulitis and continued to remain unresponsive. So we pleaded with his doctor to get him a space at the private hospital in my neighbourhood, that we always go to, and we managed to get him transferred to this private hospital in a few days.

Then, my 71 year old mother started having a low fever. My brother and I were fully vaccinated but not my parents. We had registered for the home vaccine service for the elderly, who had mobility issues but though my father used to get up each day and await his vaccination, they didn’t come until after he was admitted to the hospital. Learning that my father was infected, they said that it would be better not to vaccinate my mother at this time as she might also be infected.

Since it was a low fever, and the state that the hospitals were in, we decided that Amma should stay at home in isolation and rest. I bought a pulse oximeter and monitored her oxygen levels regularly and it was normal. Then, suddenly, on saturday, Aug 28th, morning, Amma had difficulty getting up. It took her two hours to activate her hands and feet and mouth, but she slowly got up. At times when she struggled to move her hand or feet during those two hours, I would suggest she not try so hard and to rest a bit. She would insist she needed to get up to make me a cup of tea. When she did finally get up, she asked me to help her go to the kitchen, where she made me a cup of tea. I wanted to take her to the hospital that day but she refused. For anyone who knows my mother, s/he will be well aware of her stubbornness and determination once she makes up her mind. I therefore called for the home PCR test service and had her do the test, so that in the event we needed to take her to a hospital, at least delays related to COVID testing would not be there. The whole day, she was able to walk around the house and do her usual stuff so I decided I would closely monitor her and decide the next day, on whether to admit her to the hospital. That was a mistake. On Aug 29th, I woke up later than usual around 6am and checked on my mother and apart from her breathing, she was not moving at all. I tried calling her and tried moving her hands, there was no response. Her eyes were wide open but she did not see me nor was she present. That was the scariest moment of my life. My brother asked me to make her some sugar solution but she was not drinking it. The PCR test result was emailed to me around that time and the result was positive.

Then began the next round of nightmare. Since the private hospital that my father had been transferred to was full, and no other private hospital admitted COVID patients, we decided to take her first to the same government hospital that we had taken my father first to. As I was in shock, as well as the fact that it was usually my mother who packed things for anyone’s hospital stay, I just pushed some stuff of my mother’s into a bag and took it with me in the ambulance. I thought I would be able to come back home, after admitting my mother at the ICU, and prepare better what needed to be taken both for her and me. My brother-in-law called the government ambulance service set up to take COVID patients to hospitals and they came in promptly. We faced some difficulty in getting her down to the waiting ambulance, as the trolley wouldn’t fit in the lift, and my mother’s hands and legs were totally stiff so we could not make her sit in the wheel chair initially. Eventually, we managed to transfer her to the wheel chair, after I coaxed her into bending her knee. At the hospital, after the check-in processes, I was told to take my mother to ward 15A, the point where the COVID admissions were done. There, the doctor who checked my mother’s blood sugar exclaimed it was critically low at 47 and immediately administered a glucose syringe and put her on a saline drip. By this time, she had gained consciousness and even though she was able to say a few words, she was not able to move. The first word that she said was ‘hungry’ and asked me for some food. I did not have any with me and I did not want to leave her in that public, overcrowded area unattended to go in search of the canteen. I asked the staff there for something and they were kind enough to give a juice box. Eventually, we were allowed to go to the COVID ward for women and she was given a bed. The ward had four sections. One large space with around 12-15 beds packed together, a small enclosed space with 3 beds, and a medium space with a couple of beds and the rest of the patients on the floor. Amma’s bed 19 was in the small enclosed space next to the washrooms. On bed 20, there was a woman who was connected to an oxygen cylinder. A little while later, another elderly woman was brought in for bed 18 by her son and an attendant, who promptly left after depositing the totally unresponsive elderly woman on her bed. In the meantime, I was trying to request the few staff there for a pamper because I had not come prepared and my mother was asking me to help her to the bathroom and she could not move. The response given was that they were in the middle of shifting to a brand new ward so all supplies had been moved to the new ward and they did not have any here. It was hours later before the attendant taking care of an adjacent patient, gave me a pamper for my mother and helped me to change her clothes and sheet. No one really came to check on the patients, though nurses seemed to take the pulse oximeter reading at least twice a day and blood checks. The family members caring for the patients were the ones distributing food parcels, water, fitting in the oxygen cylinders for their ill family member etc. The food that was given all three times was rice with curry and it was not considering dietary restrictions or issues that the patients might have. For example, my mother has been on a semi-solid diet for a decade or so as she has difficulty chewing and swallowing and she was not able to get up at this point due to her paralysis. I had kept the straw from her earlier juice box and used it to give her sips of water or tea from time to time. The patients on the beds adjacent to her were either totally unconscious or semi-conscious and not in any position to feed themselves but no one minded that, and simply left the food by the bedside table. It went untouched and thrown later, when new food packs replaced the old ones. I kept mentioning to the rare nursing staff that passed by that the unresponsive woman would need a drip, as she was not in any position to take in food or drink but there was no action taken until the next afternoon. The elderly woman was not even blinking her eye, even though they were wide open and there was no indication that she could hear. So, until and unless a family member or a paid private attendant was with a patient, especially one who was elderly and was not in a position to take care of themselves, their condition declined and some to critical levels.

I also realized how important it is for a close family member to be with the elderly patient. Throughout that day and night, I constantly interacted with my mother which gradually brought her out of her state of confusion, brought back some movement to her hands and feet.

There was no day bed for the carer, given that it was already an overcrowded ward with patients on the floor. I managed to get hold of a plastic chair and wedged it between my mother’s bed and the unresponsive neighbour’s and that was where I spent an uncomfortable night, sitting up. Yet, at that point, I was more worried about my mother’s paralysis and the fact that no doctor was addressing it beyond sending her for a CT scan. The bright lights were all on throughout the night and the hospital staff were very loud, using mikes to address the patients from their so-called safe cubicle. They had this habit of calling patient names, expecting the patient or the carer to go and pick up medicine packets for the patient. So, if the patient was not mobile or did not have a carer, she would not receive her medicines. Around 9.30pm that night, a new patient was brought in a trolley and since they could not take the trolley around to the large space, where there were some free beds, the ward doctor on duty told the attendant to ask my mother to move to the other space. They had no idea that my mother was paralysed and the attendant was insisting that my mother get up and walk around the corridor to the other space. I put on my fighting mode and told them that she was not moving anywhere. Finally, they brought a wheel chair and asked the patient on the trolley to move to the wheel chair and she was wheeled to the other area. The staff on duty was annoyed with my stance though and told the attendant to move my mother to the floor at the entrance of the ward. Again, I stood my ground and said that she was not moving anywhere that night and that as medical staff, they should be sensitive to a patient with neurological issues and who had come in paralysed and suspected to have had a stroke. They finally left us alone.

Anyway, I knew that I was not going to let my mother stay in that ward another night. I sent a text message to our family doctor, explaining what had happened, and to help transfer my mother as well to my father’s hospital. The next morning, he informed me that he had made arrangements and to collect the transfer letter from the hospital and bring my mother over. My brother collected the letter and handed it to me. The ward doctor that morning was a young and friendly one but for some reason, she was hesitant to approve the transfer and kept saying she was waiting for approval from her higher-ups. As the clock ticked by and it became afternoon, I stepped up my queries and tried to identify the bottlenecks for the approval process. I understood that the transfer of a patient from a COVID ward of one hospital to another required the approval of Ministry of Health and that our ward doctor was waiting for this approval, as they had not been able to get in touch with the focal point at the health ministry. Knowing that waiting for them to get the approval was not going to work, I reached out to colleagues who had contacts at the Ministry of Health and finally got the contact number of the focal point. I sent him a text message, as I was told that he was usually too busy to answer phone calls. A colleague suggested that I insist to the ward doctor that as my mother’s guardian, that I was making the call to transfer her to a private hospital and that we are waiving off any of their responsibility. I argued with the ward doctor and a colleague of hers for some time, before they finally agreed to approve the transfer. They said they would only give the discharge card and nothing else. I said, ‘fine’ but I wanted the discharge process to happen without any further delay as I was calling for the ambulance. While waiting for the ambulance, I received a response from the Ministry of Health focal point stating ‘approved’ for the hospital transfer. I showed that response to the ward doctors but they were already angry with me that they said they did not care what approvals I got as they only accepted approvals that came from the official process. Finally, around 8pm, we reached the private hospital on the same road, where we lived.

From the point that we reached the private hospital, utmost care was taken of my mother by the medical staff and within a few days, she had recovered. The doctor said that he could discharge her on friday, September 3rd, as her paralysis and COVID situation was addressed and the balance of her recovery from severe dizziness and under-nutrition was something that required long term recovery and attention at home.

So over the weekend, I transformed my room to better fit in my mother and threw out all the other furniture and any of my miscellaneous collections. Until she is completely recovered and able to walk about on her own, I am going to continue closely monitoring her condition and coaxing her to take in normal levels of fluids and semi-solid food. From 300ml daily intake on friday, I have managed to increase her intake to 750ml today. While this is still not acceptable levels, considering this is what comprises of her total nutrition intake, at least this is progress for someone who is averse to food and drink.

It is almost like taking care of a child, because every hour or so, I have to coax her to drink 50ml of some nutritional drink (as she doesn’t drink more than that at a time). She has started walking from the room to the bathroom with my support, in the mornings, when she feels a little better.

On my part, it’s been more than a week since I have slept properly or eaten normally. Since her sugar levels seem to be dropping very low during nights and she becomes numb, I need to continue giving her a little drink (Ensure or Vitagen) every hour or so. When I dose off at times, I suddenly wake up at the slightest sound, afraid to face what I did last saturday – an unresponsive, paralysed mother.

I am not who I was a week ago.

Why I decided to write this experience down is not only to get this off my chest, but also to share this with friends and colleagues who keep asking me how I am doing. I am not someone, who talks about my intense personal experiences. I write about them.

Also, I felt it might be useful to share some of my learning with others out there, who have elderly parents with health complications, as well as the rest of those who are observers of people going through similar difficulties:

(1) If your parents are not vaccinated, and your doctor has not adviced them not to get the vaccine, then do push your local vaccine services to vaccinate them at the earliest. This might reduce the severity of COVID effects on them, should they get infected.

(2) Do keep a bag ready at all times, not just for your elderly parents, but also others in the family. In the event of an emergency and you need to rush into the hospital, what are the items that you will need at hand. During the emergency, you have no time to think as you will most likely be in somewhat of a shock.

(3) Do be with your parent, should they be admitted to a COVID ward in a non-responsive state. Without your attention and care, they might not make it back.

(4) For those friends and colleagues, who want to help, please don’t call the person who is going through this until and unless you can offer concrete support. For example, some of the helpful calls I received from colleagues was related to talking to my family doctor, re-emphasizing the need to transfer my parents to the private hospital, another was regarding bringing my mother’s pressure medicines as the government hospital asked me to give the medicine to my mother, but did not provide me with them and I was not allowed outside of the COVID ward since stepping in with my mother. Other helpful messages that was appreciated was text messages with a warm thought or a specific question regarding how I was managing my meals etc, that I either responded to when I had a minute or not, but still the thought was appreciated. The least helpful and annoying calls and messages from well-meaning friends was calls in the middle of when I was experiencing nightmarish situations such as arriving at the government hospital, being in an overcrowded ward, trying to get some help for my mother and a friend called and asked me, ‘are you ok now?’. This same question was repeated over a number of times before I asked a colleague to inform all colleagues not to call me at the hospital as I was not in the headspace to respond to them. This is a particularly long section of advice but important. Please try to place yourself in the other person’s shoes. Would you want to be called by someone and asked, ‘are you ok/ now?’ when you are busy dealing with a nightmare?

I was not ok and I am still not ok.

I know I will pull through this, and will do what I can to support my mother’s recovery. My father is still at the hospital undergoing dialysis and on oxygen support, as he contracted pneumonia. He didn’t recognize me when I went to say ‘bye’ before leaving the hospital with my mother.

I will be returning to work tomorrow, and working from home for the rest of the month. I sincerely don’t wish to talk about what I am going through personally at work or with friends outside work. So, I have taken the time to write this down to share what I am going through now.

Hope my friends will understand and respect my wishes. I know all of you mean well but I am conserving my energy for what matters the most to me – my mother’s recovery.

2 thoughts on “Reflections during a stressful time

  1. It was a real hard time Ahila. Really appreciated your level of commitment and affection with your parents amidst Covid thread. It has brought back my experience in early 20s when admitted my father at a Hospital in Colombo during the peak of internal conflict in Sri Lanka. Be confident and hope your parents are recovered now. Your experience may give confidence to face any difficulties in our day to day lives for many specially during this pandemic situation.

    Like

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