番茄社区

My 85-year-old father loved people, and he waved hello to everyone as he tooled around a Southern California assisted-living facility in his tricked-out electric wheelchair. He couldn't resist talking to a neighbor at his doorway when the building went off pandemic lockdown a few weeks ago. They couldn't hear each other, so they pulled off their masks for a quick chat. How-are-ya, fine-thanks. What a year!

Maybe that was the moment the germs slipped into his chest.

Perhaps one of the caregivers brought the virus into his apartment from the outside. Or he could have been infected when he visited a vascular surgeon.

We'll never know for sure. It is clear, however, that COVID found its way to my father and took his life. But not before a long, complicated, and agonizing cascade of medical complications that left him exhausted, alone, and afraid.

Novelist Philip Roth wrote that "old age is a massacre." It's got nothing on the horrible effects of a new deadly combo – the coronavirus, hospitalization, and isolation.

The Rock of Our Family Gets a Positive Test

The story of how my parents met is literally a tall tale.

In the late 1960s, Ralph Dotinga – the son of Dutch immigrant dairy farmers -- was a 6-foot-6 teacher at a suburban San Diego elementary school. The ladies in the faculty lounge noticed his height and coaxed him to sit next to a fetching 5-foot-10 colleague. They knew what they were doing: It didn't take long for Ralph and Sudelle to both invite their classes to their wedding.

Dad would go on to have two sons with Mom and teach elementary school for more than 30 years. , two students from his fifth-grade class in 1960 separately reached out to me about his legacy: "There must be many hundreds of people out there who will ," one wrote.

At home, Dad was the rock of our zany and complicated family, the anchor who kept us from running aground as we navigated rough waters. The health problems and the endless hospital visits came late in life after a pleasant retirement overlooking a golf course he loved to visit.

Somehow, he survived two heart attacks, one cardiac arrest, a quadruple bypass, diabetes, and crippling falls. Pretty soon, I predicted, they'd name a hospital wing after us. Funny, he said.

Nonetheless, to borrow a phrase, he persisted.

About a week before Thanksgiving, Dad fell and went by ambulance to the emergency room. He'd cracked a bone in his knee and couldn't stand up. They got ready to send him to a nursing home for rehab – a drill he'd been through multiple times before -- but first they gave him a COVID test. It was positive.

This was the .

Isolated and Alone, the Complication Cascade Begins

Dad had no COVID symptoms then, but he was stuck in the hospital. Only a pair of nursing homes in the county, we were told, would accept COVID-positive patients. They were full, we learned, or didn't return phone calls.

San Diego County is home to 3.2 million people, roughly the population of Utah or Connecticut, and there was no room for my father. Then again, maybe we dodged a bullet. Those two nursing homes had gotten bad press. "El Cajon Nursing Home Reaped Big Profits While Shortchanging Resident Care, Analysis Shows," . The from the National Guard when COVID overwhelmed its staff in November.

A few days passed, then Dad complained that the hospital food was more terrible than usual. His sense of taste was out of whack, a classic sign of COVID. COVID pneumonia soon set in as his oxygenation level dipped. He didn't need a ventilator, but he went on oxygen and began a remdesivir-steroid regimen. No expensive fancy drugs for my father, though. He's not the president.

Dad remained in good spirits for the most part, and he started reminiscing about his life. "I love your mother as much as anyone could love someone," he said. "He must be delirious," Mom joked when I told her. My response: "That's what I said!"

Mom, unfortunately, was in for her own struggles amid a massive coronavirus outbreak at the assisted-living facility. About a week after Dad went to the hospital, a brutal bout with COVID left Mom afraid for her life and almost too weak to stand. A widow now, she's still recovering.

Back at the hospital, Dad came down with a blood infection with MRSA, the horrific superbug that hangs around medical facilities. As patients and families learn every day, it's dangerous to be extremely sick in a place full of germs.

The medical team installed a PICC line to administer an antibiotic for 6 weeks. Then disorientation set in.

A Text with a Single Word: 'Help.'

Dad called me 3 times at 4 a.m. one day to ask me to call 911 for him; another time he texted "help" to me from Room 993. I'd never seen him send a text before.

He was fine, his nurses said, just confused. I don't know if they comforted him or held his hand. In the era of COVID, we couldn't be there at all.

Delirium and disorientation are common in people who are hospitalized, and it's especially common in isolated patients with COVID who are treated by medical professionals with their faces covered by masks, shields, and goggles. "This is a perfect storm for delirium. The best thing for patients with delirium is to get them out of the hospital and into familiar surroundings," said hospitalist Charlie Wray, MD, of the University of California at San Francisco, in an interview with 番茄社区. "But when people stay in the hospital for prolonged periods of time, we often tend to find more reasons to keep them there."

He means that complications crop up like Dad's MRSA blood infection.

The pneumonia cleared up after a few days but my dad remained positive for COVID so he couldn't leave for a nursing home to get rehab for his leg. His muscles deteriorated since he was unable to get out of bed on his own.

Weeks passed, and more problems appeared. They put him on blood thinners to prevent COVID-related blood clots, but he had bleeding and bruising, and they stopped the regimen. Then he had a urinary blockage that caused pain until they cathetered out 2 liters of urine. He became so drowsy that nurses new to him never got to see the warmth and charm – "what a sweet man!" -- that their colleagues spoke about weeks earlier.

After Almost 5 Weeks, the End of a Story

Dad spent much of his last week asleep. Three nights before Christmas, he wouldn't wake up when they tried to rouse him. Tests didn't reveal a cause. The doctor talked to me about what my father and our family would want for him if things didn't improve. He hoped my dad might respond to a medication for his suddenly abnormal liver enzymes, one that would be given through a nasogastric tube, and I approved giving it to him. But he passed away around 2 a.m. as the team prepared to administer the drug.

The doctor told me the cause of death will be COVID. It appears to have caused a fatal stroke – one of the things the virus does.

Dad was at the hospital for just shy of 5 weeks, isolated and alone. This was no way to live, and no way to die.

This kind of endless saga isn't unusual. Not everyone in the hospital with COVID lives to tell the tale or dies after going on a ventilator. Some stay longer than a month, making it more likely that they'll get other diseases like hospital infections and suffer from the effects of not moving around like losing muscle tone. And the lack of space in nursing homes – remember that none had room for my COVID-positive dad? -- means that hospitals can't discharge patients when they're ready to leave.

"If someone occupies a room for 2 to 3 weeks recovering from a disease, that's 2 to 3 weeks in which that hospital doesn't have that bed," San Francisco hospitalist Wray said. "That's longer than what usually happens, and that's a complicating factor in this pandemic that a lot of people don't fully understand. Simply put, we've got the spigot on, filling up the tub, while the drain is partially plugged."

'You Are More Likely to Die from a Lightning Strike'

Some people will say my father was old and sick and due for death. Maybe. But Dad did have a very important pre-existing condition: He was alive. And then, thanks to COVID, he wasn't.

There's also this fact: COVID had to work so hard to take my dad's life that it seems like he had more time to live, to be a husband and father and friend. Ending this way – alone, isolated, and robbed of human touch – is so brutal and so needless.

We've been failed by so many careless people who've allowed this pandemic to grow and kill so many. The politicians, starting at the top. The local megachurch we attended when I was a kid. ("You are more likely to die from a lightning strike than the COVID-19 virus," .) Craven business owners, apathetic diners, and the heartless anti-maskers.

I'm my dad's son, and I'm generally good-natured just like him. Anger always seems unnatural to me, and I usually can't sustain it for long. But if enough people get furious and stay furious, maybe we can make this stop.

It will be expensive, and it will be hard. So what? I'm hardly the first to say this, but I know it now more than ever: The cost we're paying is more than we can bear.

Randy Dotinga is a San Diego freelance journalist and 番茄社区 contributor.

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