We are pretty fortunate here in Northeast Wisconsin. Our COVID hospitalizations are much lower than in late 2020/early 2021, but early morning on Friday I had a reminder that this disease is still deadly, still a threat to people of various ages, social statuses and health statuses. Yes, we’ve made great strides in vaccinations in our state, and our medical practitioners have learned so much that improves the care we can provide to our COVID patients, so survival rates are far better than before.
We’ve been averaging just 1-3 COVID patients a day with active disease in the last couple of months. I’m not counting the people who have had COVID and are struggling with full recovery from damage done by it, who tend to be in an admission-discharge-readmission cycle, but those who have recently been diagnosed and admitted. Two people have died of it in the past week, one of whom had a lot of complicating factors, and felt ambivalent in the past about following medical recommendations regarding his pre-existing conditions. That one happened on one of my days off, so I didn’t have direct contact with the family.
On Thursday of this week, I was on-call, and found out first thing in the morning from the ICU night RN that two patients had had very difficult nights. One was “Margaret,” who had been admitted about 15 days earlier and ended up on a ventilator after a couple of days of O2 saturation levels that kept dipping dangerously with other types of O2 supplementation. When she first came to us, her husband, “Joe,” also had COVID and was pretty ill himself, although he never became an inpatient.
Margaret’s change in condition surprised me a bit. On Tuesday at rounds, I had heard talk of perhaps being able to get her off the vent soon, although if that did not prove possible, she would need a tracheostomy and a more permanent feeding tube, since staying on a vent more than 2 weeks can be damaging. Our ICU MD had been communicating all this to her husband daily.
When I heard on Thursday morning about the problems she experienced during the night, I called Joe at home. He said he was physically recovered, but was terribly worried about Margaret. I answered some questions he had about visitation should her condition worsen, since their two adult children were worried they’d never see their mom again. I told him if it came to a situation where she was unlikely to survive, there would likely be a chance for the family to be with her (that has changed from the early days of COVID care). I also explained that an RN could page the chaplain any time for family support, for prayer if desired, or just to talk. We both knew the doctor still had a couple of interventions to try before he would recommend a transition to comfort-only measures.
Maybe I shouldn’t have been too surprised to be paged that night around midnight, but I was, a bit, because the daytime RN said they were seeing slight improvement from the CRRT (a form of continuous kidney dialysis) they were trying to reduce her fluid buildup. I was glad I had called Joe, because he and the adult kids were there and requesting that a chaplain come.
Margaret was only a few years older than me (I’m 60). She had just retired from her job, and taken a celebratory trip with some friends. The balloons from the day of her retirement are still in her house. She was very careful with COVID precautions prior to the trip, and now Joe was blaming himself for not trying harder to talk her out of going. She came back with COVID symptoms, and then she and Joe both tested positive a few days later. She didn’t have any chronic health problems prior to this other than some blood pressure problems and being a bit overweight.
Her stoic son and weeping daughter were in the room. Her daughter will have her third baby in June, and Margaret was so excited about being more available now to help with the baby, than she had been with the older two kids, now 10 and 11. After Joe and I talked privately for a while, he said he was sure that Margaret would not want to be kept alive artificially like this, and he knew that soon, even the ventilator wouldn’t be sufficient (turning the rate of air flow up more would have blown holes in her lungs). It was time to remove the breathing tube and let Margaret pass. He wanted some prayer offered at the bedside, which I did, along with a scripture reading befitting their Lutheran faith. The RN reminded me that we sometimes have quilts available to give to dying patients; unfortunately, when we searched, we found we’d used up our supply during COVID. I found a prayer shawl in our spiritual services storage room, and offered the family a choice between a couple of those. Her daughter selected one, and we draped it over her; her daughter has it now.
After the prayer, the family left the room, and the respiratory therapist and RN went in to complete extubation. Family went back into the room. I heard loud cries from their daughter in less than five minutes. Margaret was gone, along with her dreams of being a retired grandma with lots of time for the new baby, and extra time with her husband, son and friends. The family left with their hearts roughly broken, and knowing they would face a life they’d never imagined would come so soon. A life without Joe’s wife, without Mom and Grandma for son, daughter and grandsons.
I find it especially sad to face these deaths now that our relief is so close. A friend from church choir who is also my neighbor died of it a couple of months ago, after getting her first dose of vaccine. She, too, had been really cautious and adherent to precautions. She’s the first person I had known outside of my hospital patients who died of the disease, and I feel her loss every time I see her husband sitting alone on their front porch, where I sometimes stopped to chat with them (wearing masks) in recent months. There are still holes being crudely punched into many lives. Please don’t forget these current victims. Please, if you haven’t gotten a vaccination, schedule one. Every death from COVID is tragic; those occurring now that we have a means of greater prevention, are especially painful.