|Photo by Craig Whitehead on Unsplash|
My father died last year from what I call “Covid cascade,” a series of unforeseen consequences that ensue when Covid-19 breaks out in a healthcare facility. My father did not have the virus at the time he died—in fact, he tested negative three times. I write this hoping it will raise awareness in other families of the sometimes invisible dangers posed by Covid-19.
Before the pandemic, my brothers and I drew on my experience to get our father as well situated as possible. He was ninety-one and had debilitating Parkinson’s disease but not dementia. Thanks to Dad’s wise investments, we were able to pay more to keep him living in a “skilled rehab unit” that attracted a talented staff who were retained for years at a time, quite a rarity in long-term care. While the rest of the building had a typical residents-to-caregiver ratio (pre-pandemic), my father’s unit had, on an average day, about 30% more staff on duty.
After March of 2020, when all visitors were banned, we taught the staff to turn on a Zoom conference and let him chat with his loved ones a few times per week. Zoom allowed him to “travel”: he attended live Easter Mass at St. Patrick’s Cathedral in New York City and saw my grandmother’s irises in full bloom where they had been transplanted into my garden two states away. He was a bit bored with no live sports on TV, but he was as well-attended as possible.
All this changed as Covid-19 surged in his area. In contrast to most nursing home plagues reported in the media, with common rates of about forty infected patients to four infected staff, my father’s building had about twenty infected staff and four Covid-19 positive patients. Since there had been no access to the facility by anyone except residents and staff since early March, it seems clear that the patients acquired the virus directly from their caregivers.
The effect of the outbreak was to isolate my father from his usual care. With elective surgeries canceled, the large, free-standing unit was no longer financially viable. His long-term caretakers were reassigned and the nearby nursing desk shut down. Replaced by a new “Covid Unit” with a Plexiglass-type barrier to direct airflow away from his room, he was alone at the end of a corridor. With word of the outbreak in the local media, the facility reported an inability to recruit and retain adequate temporary staff.
Word came suddenly on a Monday night that he had fallen in his room. Reaching him by phone, he told me he just wanted someone to close his shades against the summer light, but nobody came for his call button anymore. The staff that had disappeared were always careful to place his walker where it was readily available to him at all times. But this time it was across the room. And yet Dad thought he would be able to maneuver himself to the window and back without it. He was found on the floor by the shade pull.
Believing his hip was merely bruised, a nurse and a covering resident at an affiliated hospital recommended ibuprofen and acetaminophen, so Dad was lucid, making self-effacing jokes, and asking whether he should be transported to the emergency room. We agreed that rather than assume the risks of transporting him to the hospital late at night, in the morning a mobile imaging machine would be brought in to assess him.
I called the staff by 5 am and was told he had slept well, but when I called again at 8:30 a staff member reported he did not want to eat or drink and “looked bad.” On the phone with me, he could not make himself understood well and seemed to be out of breath. He went downhill very fast from that point onward.
Many families have recounted the heartbreaking Covid rules in nursing homes, which dictate only one thirty-minute “compassionate last visit” while fully masked and gowned. I received my pass by e-mail at about 12:30 pm and began the two-hour drive. I entered the facility just after 3 pm and found Dad trying to respond to me, but in abject pain. I asserted that he needed morphine now. The facility physician offered: “Maybe I’ll be able to get a time-released fentanyl patch for him at some point?” I knew of a beautiful freestanding hospice house nearby and called for an affiliated nurse to say that I wanted Dad transferred there. But the hospice had strict rules not to admit Covid-exposed cases lest they endanger other dying patients and their staff.
Because of the outbreak at the facility, the state CDC had prioritized extensive testing on site. My father had just had three recent negative Covid tests and lived alone, so this documentation was his passport out. The transfer was arranged, but only two people were allowed to be with him in his hospice suite, myself and one of my brothers. They kindly allowed Dad’s favorite “granddog” in, too. We kept vigil in his quiet room. Staff looked the other way when we bent the rules, opening the window to let him smell the summer air.
Once he was comfortable on medication, we “love-bombed” him continuously, telling him he was the best dad ever. A modest and polite man of his era, he never liked to be fussed over, but we could see him mouthing the words, “Thank you.”
After four days and nights, the time drew near. Our dog shifted abruptly from his dog bed into a spot below dad’s bed, directly under his heart. The Parkinson’s shake in one hand that he had attempted to hide behind his back for over a decade just disappeared. Around midnight as my brother and the dog snored loudly, I tried to listen to Dad’s breath. I checked the news of the virus on my phone for less than a minute, and when I turned my attention back, I felt his heart and knew. He took his moment to depart without all that embarrassing and excessive love talk.
I can try to forewarn other families to protect against more than just infection when considering the consequences of Covid-19. But my cautionary tale boils down to advising a vigilance that may be useless. At this point, if some staff in health care facilities continue to refuse vaccination, as is the case in every state, I do not know what actions can prevent the collateral damage from Covid outbreaks in nursing homes and hospitals across the world. There is a parallel staffing crisis amongst home health workers.
We will simply never know why my dad declined so quickly. Did he hit his head in addition to what turned out to be a fractured hip? Did he bleed internally? Was it the horrible shock that somehow put him into a rapid decline? My father’s death was not from Covid. But he was one more casualty of the Covid cascade of tragic consequences.
HELEN MELDRUM is an Associate Professor of Psychology at Bentley University in Massachusetts. She received her doctorate from Clark University, a master’s in Counseling and Consulting Psychology from Harvard University, and a baccalaureate from Emerson College concentrating in Communication Education and Psychology. She won the Researcher of the Year Award from the International Listening Association in 2012. Her newest book is titled: Characteristics of Compassion: Portraits of Exemplary Physicians. Active as a consultant for over 30 years, clients have included: Bayer, Glaxo, Abbott Labs, the Pharmaceutical Society of Australia, Academy of Oncology Nurse & Patient Navigators, and Pfizer.