“I just watched her… suffocating. In her own fluids.
I kept asking if she wanted more help, if she wanted to go on the ventilator and all she was able to say was, ‘No’.
I don’t know what to do, M. I don’t know how to help her. I can’t…
I can’t watch her suffer anymore.”
Pixelated tears turned into currents streaming down the face I’ve loved since I was 13.
We’d been through a lot together the last 22 years, X and I. From high school boyfriends, jamming out to classical music in her 80s Buick with maroon velour seats and receiving my first mixed CD (illegally downloaded from LimeWire, no doubt), to weddings and family vacationing in the PNW with her mini-me later.
Through all that, I’d never seen her like this.
But then again, it’s not every day you see your mother gasping her last breaths in front of you.
I thought back to the last conversation we’d had face to face, when I finally went back home to the Midwest for the first time in 2 years. The difficult conversations she and her husband had with their parents, trying to convince them to get COVID vaccines, even contemplating using their vulnerable children to guilt the grandparents into get immunized.
All the grandparents refused. Her mother refused. Personal freedom of choice, they said.
And when I opened my phone before deplaning at the end of the trip, the inevitable outcome of those fruitless conversations greeted me:
“I’m in the ER with my mom. She has COVID.”
That was 3 weeks ago.
3 weeks of high flow nasal cannula with maximal oxygen settings, just a step down from full ventilatory support. By the time X’s mother made it to the hospital, it was too late to give any of the monoclonal antibodies or antivirals she’d used as a reason to not get vaccinated. Steroids weren’t helping. The scarring in her lungs had already compromised her ability to exchange oxygen.
3 weeks of visiting her mother once, even twice a day – juggling childcare, work and extended family anxiously awaiting updates. 3 weeks of watching her get progressively worse instead of better, quickly dropping her oxygen saturations as soon as the high flow support was removed in order for her to eat. 3 weeks of horror while X watched her mother’s grasp on English disappear as she returned to her native Spanish, because it took too much effort for her to make the translation.
X’s initial fears of no end in sight were now preferable to what she faced today – she did see an end.
And it didn’t look good.
As X gave me the update, I became increasingly unsettled by how detached I felt from this woman suffering in a hospital bed. Was I really shrugging and thinking to myself, “This is what happens – it’s called natural consequences,” about someone who was essentially my aunt during my teens? Had the pandemic really leeched out all my sympathy for even the people in my life?
A sniffle brought my awareness back to the FaceTime call.
“I don’t know how you do it, M.
How you see all this shit and deal with all of the anxious family and still manage to be ok. I don’t know how you go back to work the next day.”
Define OK
Was I OK the first time I saw a 2 year old with RSV using every last bit of energy to breathe? The way his skin sucked in and out between his ribs – was I unaffected? Watching his half-closed eyelids barely register his mother’s tears as she rocked him back and forth, terrified of what was going to happen next – how did I feel in that moment?
Contrast that to the last day I was senior resident in the ICU, watching a woman throw herself down on her fiancé’s bed screaming his name. The way his lips and skin swelled taut around the endotracheal tube keeping him alive, just long enough for his family to say their last goodbyes. Focusing on the rhythmic sound of the ventilator, breathing in tandem with the machine – in and out, drowning out the mayhem around me but still aware enough to answer questions once family was ready.
Gone were the wide eyes, unnecessary were the efforts to suppress my racing heart beat and trembling hands.
Present AND detached – wasn’t this the ultimate goal of completing medical training?
How do we manage?
Maybe we don’t. Maybe we compartmentalize and lock these experiences away until out of nowhere, a random memory sidelines us when we least expect. Maybe we see so much constant suffering, it becomes our new normal.
But our first encounters – we always remember our first.
Especially if it involves someone we love.
But that’s not what X needed to hear.
That the memory of her mother’s straining neck muscles and pursed lips would forever be etched in her mind. That she’d replay the conversation about COVID and vaccines over and over, trying to wrack her brain of where she could’ve done things differently. How things might have played out another way if she’d just spoken up when it was clear her mother’s husband had gone down a Facebook rabbit hole and emerged with a lifetime of conspiracy theories and unshakable faith in ivermectin and hydroxychloroquine.
She would meet these challenges in their own time. But not right now.
Suddenly, two little balls of energy entered the screen.
“Mommy, you crying?”
“Yes, mommy’s sad. But I’m happy to see you! Come, say hi to M.”
X’s little 1 and a half year old reached up to wipe her mother’s tears with curious fingers as her older brother waved vigorously at me. X wrapped them into her arms, burying her face in their dark chestnut hair.
“Sorry,” she said as she came back up for air after a few moments.
I arched my eyebrow.
“Oh, yeah. I’m supposed to stop apologizing. Sorry.”
Laughter breaking the tension, X gave me her first smile of the day.
“The kids… they’ve been so great through all this. I’ve just been coming home from the hospital and giving them the biggest hugs and kisses.”
Smiling back, I spied their little heads bopping in and out of the screen.
“I think… that’s how we do it. We hold on to the good things in our lives to help us ride out the bad. Like I just watched you literally hold your kids. Sometimes it’s the little things that keep us afloat.”
X let out a big breath as she nodded.
As I watched her resolve grow, an unexpected rush of tears flooded me.
I might not have any more empathy for her mother, but it was too hard to watch X’s heart break and reassemble.
And yet, I couldn’t look away.
I was in awe of this amazing woman – how she continued to smile through her tears. How her softness didn’t take away from her strength but rather made it even more impermeable. How she made MORE room for the loves in her life while the love for her dying mother threatened to wreak havoc to her foundation.
Maybe this was my way through – to see and support the loved ones of people whose choices I couldn’t fathom.
I may no longer have it in me to try to prevent the hurt coming their way, but I can still do damage control for those left standing.
This could be how I choose to keep showing up, day after day, approaching year 3 of this pandemic.
It’ll have to do… for now.
***
Photo taken of me hiking through Bryce Canyon, Utah.
***
These last 2 years have been awful.
For everyone, personally and/or professionally.
If you’re a healthcare worker and are struggling with your mental and emotional health, please know there are FREE, confidential resources:
In addition, if you’re a physician/medical student, you can call the Physician Support Line to speak to a psychiatrist at 1 (888) 409-0141, 7 days a week, 8 am-1 am EST.
Take care, my friends.