Life During Wartime

“This ain’t no party, this ain’t no disco, this ain’t no fooling around” – Talking Heads

If you are one of those people who still thinks the COVID-19 virus is unlikely to change your life, think again. We are witnessing the worst-case scenario of a global war against a highly contagious virus that requires all of us to do our part to contain its spread, particularly to the most vulnerable among us. Here in Italy as of today there are more than 15,000 known cases of the Corona virus, 11,000 of which happened just last week. 

From New York Times March 13, 2020

Hospitals in the north where the spread began are overwhelmed, desperately seeking to create intensive care beds for the overflow of dying patients. This New York Times piece (no paywall on Corona news) provides a grim glimpse into the future scenarios likely to expand globally.

Italy has now taken the most drastic measure of putting the country on pause – no school, no work, no play – and is using celebrities and doctors to spread the #IoRestoACasa message that staying put, in the safety of one’s home, is the best way to contain the spread of disease. Now only supermarkets and smaller food stores plus pharmacies are open, and you have to wait your turn to get in. When I ventured out to the pharmacy yesterday, there were about ten people waiting not in line, but with the required meters between them, each new arrival confirming who was the last person so as to keep track of turns. This sort of civility is rare in Italy where cutting in line, especially at airports, is more the norm. Masks and gloves are everywhere, and supplies of hand sanitizer seem to have run out.

Against this surreal backdrop, my life as a caregiver goes on with the daily joys of watching my mother get better and better with each day. Even her bloodwork yesterday shows dramatic improvements in the worrisome numbers. When we first got the hammock-like lifting machine to transfer her from bed to reclining electric armchair, she actually loved the whole experience, and stayed in the chair for 30 minutes. Just yesterday she stayed for three full hours, eating dinner in the chair, and during her physical therapy session managing to stand three times holding on to the bed frame while we supported her on either side. For the first time we saw her move her feet on her own, taking little steps as we pushed the armchair into position, and turning her ankles in circles to stretch the muscles. This morning I left her room for a few minutes and returned to find her sitting up, legs hanging down the side of the bed, torso up, with only the yoga belt barrier I put in place as support for her hands. She is ready to, as she says, “get out of here.”

Also remarkable is the dramatic difference between her speech when she is lying in bed compared to when she’s sitting up in the chair. Moans and groans turn into full-blown phrases of thoughts her brain has been likely storing up for eventual use. Her physical therapist recommended putting

Maureen loves the armchair

objects she enjoys out on a table in front of her, so I got out her box of costume jewelry necklaces and bracelets, and she reached forward with delight, holding each one as we talked with her and had much more meaningful social interaction than when we are leaning over her in bed, taking her blood pressure or helping her to eat and drink something.

I shudder to think how all of this would have been different if we had decided to put her in an ambulance and take her to the Umberto I hospital when she first had the crisis after her colonoscopy and endoscopy hospitalization. I doubt she could have survived. Alzheimer’s patients are particularly prone to terrible disorientation and panic attacks in hospital settings, and she would have increased her risk of exposure to germs, bacteria, and of course, the COVID-19 virus. With her weakened lungs and heart, she wouldn’t have had a chance.

So please, take this pandemic seriously. For you, for your loved ones, and for those who are most vulnerable. They need you.

Nursing Back to Health

Nurses, like teachers, are some of the hardest working, underpaid, under appreciated professionals and they are on the front lines of health care with the most direct contact with patients. Here in Rome, just as in New York, they come from countries across the globe, many hoping to earn enough to help family members they left behind. Their hours and shifts are crazy, well beyond a straight 12 hours, and often requiring being awake all night.

My mother came home from the hospital on February 13^th, and all was going pretty well until a few days later when she became bedridden. Her doctor came for a visit when a nurse was here and they determined she needed a catheter, so I raced to the open pharmacy to get supplies and after a tortuous few minutes it was in and there were within minutes two full liters of urine filling up the bag. Apparently the bloating resulting from the endoscopy and colonoscopy perhaps coupled with side effects of anesthesia caused her bladder to back up, which might also explain her high creatinine level above 3. It was touch and go for the next several days, requiring sleepless nights, gas pain, difficulty breathing, anxiety and delirium. I feel as though I have jet lag from a trip to Los Angeles for about two weeks now, and I am definitely feeling that I am too old for this.

I have learned a lot about nursing and caring for an elderly bedridden patient in the past weeks. The doctor has been in constant contact through messages and took a one-problem-at-a-time approach, so first we worked to stabilize lung edema issues using intervals of oxygen, the diuretic drug Lasix, and extra inhalers beyond the ones my mother usually has for asthma. Then once her breathing improved, we shifted our focus to her heart, slightly modifying the medication regime (she had still suspended many of her previous medications) and taking her blood pressure regularly. I kept charts of all the data including what she ate and drank and anything else noteworthy. Once I became incapacitated by sleep deprivation, I hired night nurses so that even though I woke up regularly anyway, I was sleeping in my bed more than I had been in the makeshift one next to my mother.

This all paid off and slowly but surely, we turned a corner and she seemed out of immediate danger. Her bloodwork numbers were going in the right direction. We had avoided an ambulance and hospitalization through teamwork and good communication, and Maureen’s ability to fight the impulse to give up. Every day she ate more, gained strength, was more present and herself, giving sweet hand caresses to the faces of those caring for her, winking, smiling, sometimes even singing. Frank Sinatra is an excellent healer. There were also battles to move her body, when she would threaten with fists clenched, “I’ll kill you!” but once in a comfortable position she settled right back down.

I worked in the kitchen and in my shopping to make smooth, easy food taste good, while following dietary guidelines for kidney problems and diverticulitis. Squash, carrot, and sweet potato soup. Omelets with cheddar cheese. Lemon flavored meatballs. Juice mixes with the sweetest fresh oranges and pure aloe plus her usual morning probiotic. Hot Irish tea with milk and sugar. Creamy yogurt in her favorite flavors. Cooked pears and apples pureed with banana. Lots and lots of zucchini minus seeds drowning in delicious olive oil. Thank God for soft sippy cups that made drinking in the inclined hospital bed we rented possible with little mess.

Finally, four days ago, my warm and creative physical therapist agreed to work with Maureen and see if we could get her to sit up on the edge of the bed with her feet down. Since it was close to our regular happy hour time, I told her she could even enjoy a few sips of wine if she’d try to do it, and we put on some upbeat jazz music. We slowly progressed from massage, to movement, to pillow readjustments, to a three-person (assisted by the nurse moving pillows) maneuver that slid her into position with an armchair pillow rest cradling her back. For the first time in over a week she had a different perspective out her bedroom window, and she seemed surprised to see it. I gave her the promised sips of wine, I cried, composed myself, took a picture to send my sister, and just marveled at what all that hard work had produced.

In addition to learning to do belly injections the right way with no pain and no black and blue mark, to change a really messy diaper (double gloves!) without taking forever, to treat bed sores (a rotation of three products seems to work best) and foot blisters, to get creative with pillows of all shapes and sizes, to administer oxygen with a patient determined to remove it, to change and reposition my mother all by myself (THAT was hard but now I’m a pro), to manage a catheter, and to not lose my patience every time I had to get back up just after falling asleep (I really understand those new mothers who look at their newborns in exasperation), I learned that I had to also administer some self-care. I thought about that airplane safety rule about putting on your oxygen mask before helping someone beside you. So I returned to doing my gyrotonic exercise hour with my teacher, crying with joy at my ability to do the familiar movements after my ankle surgery. I made a point of shopping at my favorite market, and chatting as I always do with the vendors I have befriended who make this chore so pleasant. I didn’t try to do everything, and trusted that Irene and Arianna were perfectly capable of being in charge of things too. I took time to make myself some comfort food, to watch my favorite Italian show, to even have my weekend martini.

And finally, blissfully, I got some badly needed sleep.