Thread by @hinapatelRx

Diary of a Sad Woman - why I hate COVID. Sun, Oct 15th - my brother picks up my mom who has just spent 2 weeks in Florida staying with my aunt post uncle’s death.  Mom/dad had both attended my uncle’s funeral 2 weeks earlier.  Mom comes back feeling sick.

Oct 16-26th - my family has “flu-like” symptoms.  Mom has been in bed since she got home.  My brother and dad start feeling weak later in the week. Mom/dad see their primary care physician on Oct 25th where he tested them for COVID antibodies which came back negative on the 28th.

Thurs, Oct 29th - I received a call from my sister stating that when she spoke to my dad that morning, he sounded short of breath.  I’m sitting at Panera bread working because I had lost power overnight due to a storm. I FaceTime dad and ask him to check his pulse ox. (Cont)

(Cont) I can see his hands shaking as he was trying to install the battery into the pulse ox.  I stay on FT until he gets his reading.  89%.  I panic.  I tell him to get to the ER right away.  In hindsight, I wish I would have kept my cool.  (Cont)

I call my bro/sister-in-law (SIL) to rush him to the ER. As they prep him, I jump in the car to drive 6h to come home. My SIL has to drop dad off at the ER and is unable to go in with him. He is admitted and sits in the ER for the next 36h until they find a bed on the COVID unit.

He gets a CT scan of his chest.  ID is consulted.  His test results come back positive and he is started on remdesivir, dexa, and enrolled in a trial for CSL-312.
I arrive home late early evening.  Mom seems ok, just weak.  My brother looks like absolute shit.

Fri, Oct 30th - dad gets a room on the COVID floor.  He is placed on high-flow oxygen.  Meanwhile, bro is feeling awful so SIL takes him to the ER. He’s home within a few hrs with a zpak.  His test comes back (-).  I disinfect everything in the house top to bottom daily.

Sat-Sun, Oct 31-Nov 1 - brother with high fevers (up to 102.8°) all weekend. We give Tylenol around the clock.  He isn’t keeping up with food/water intake.  1° care MD changes antibiotics to Ceftin.  He’s starting to feel “loopy”.

Mon, Nov 2 - SIL takes bro back to ER. His test is still (-). They ask if he wants to be admitted. He says yes. SIL and I are thankful so we can get some rest. His room is a few doors down from dad. We don’t tell my dad to avoid additional stress.  (Cont)

(Cont) I’ve been FT’ing dad daily.  He hates it in the hospital.  He says that he will be finishing up 5d of tax and coming home.

Tues-Fri, Nov 3-6th. Father and son both getting treated. Dad is now going b/t CPAP/high flow. ID decides dad should get a total of 10d of tx. Dad is frustrated. He tells me he’s scared multiple times.  It breaks my heart.  (Cont)

(Cont) I tell him to be patient and let the drugs do their thing and let his lungs heal. I head back to ATL for a few days and come back by the end of the week.  My older sister comes to stay for a week.

Sat, Nov 7th - brother comes home.  He feels much better.  Meanwhile, dad still alternating between CPAP and high flow.  He has positional desaturation.  They can’t really prone him or put him on his side.  He is counting down the days to come home.

Mon, Nov 9th - I’m back in ATL.  Dad FTs me and shows me the dry erase board.  “Look at the date, look at the date, I’m supposed to be home!  Pick me up right now!”  I want to cry.  I try to reassure him that he just need more time for his lungs to heal.

Tues-Wed, Nov 10-11th - RN lets me know dad isn’t eating due to cont. CPAP. He has another CT scan to rule out a PE b/c his sats are ⬇️. Again, he tells me he is scared. I hate that no one can see him and that he is alone. Wed. evening, dad can barely open his eyes. Panic sets in

Thurs, Nov 12th - as his healthcare proxy, I get a call in the morning that they are having trouble bringing up his sats.  He had been pulling off his mask the past few days. The rapid response team is in the room.  “Would you like for him to be intubated?”  I say yes.  (Cont)

(Cont) We, as a family, had discussed his living will earlier in the summer.  I knew what his wishes were.  Dad is transferred to the ICU that day.  He gets another CT scan.  He undergoes a bronchoscopy.  They pull a few mucus plugs.  “His lungs look fibrotic”.  (Cont)

(Cont) Dad is on 85-90% FIO2.  I pray, and pray, and pray that the vent will give your lungs time to heal.  Dad’s labs look awful.  Elevated d-dimer, ferritin, LDH; very low platelets and albumin....all markers of disease progression.

Fri, Nov 13th - we learn that my aunt died from COVID.  She too had been admitted 10 days before him.  We never told dad how sick she was.  This was the same sister who had lost her husband just a month earlier (non-COVID).  Our families are devastated.  (Cont)

Dad is fluctuating between 70-90% FIO2 on the vent.  He has severe ARDS.  His P/F ratio is <100.  As a former CCM pharmacist, I know his lungs are like a brick.  The attending shows us his 2 CT scans and I see the progression and the ground glass opacities.  (Cont)

(Cont) He barely has any functional lung.  Over the weekend, he develops acute renal failure.  He receives CRRT to remove fluids.  He is requiring minimal pressors.  I pray, and pray, and pray that he pulls a Tom Brady and comes back to beat this.

Sat-Sun, Nov 14-15th - we see dad daily via WebEx. It breaks my heart seeing dad intubated. He’s not the same man. Prior to all this, dad was 100% functional. He could walk miles with no problems. Dad was with me hiking in the Himalayas less than a year ago. How did we get here?

Mon, Nov 16th - I fly home again from ATL.  All the driving was too much.  My older sister flies home to ATL and my younger sister goes home to her kids.

Tues-Wed, Nov 17-18 - dad is fluctuating between 70-100% FIO2. He is still requiring minimal pressors and low dose sedation/analgesia.  I’m still hoping dad gets through this.  He’s always been a fighter.

Thur, Nov 19 - the attending calls with an update.  He has a new RML and RLL consolidation.  They start vanc/meropenem.  The worst update......dad is not waking up at all.  A head CT has been ordered.  The pharmacist in me says it’s lingering sedation.  I’m in denial.

Fri, Nov 20nd.  The CT scan is done today.  It’s shows multiple infarcts with an SAH.  I call my sisters to come home stat.  We decide to wait to tell mom until Saturday when we are all together.  We decide not to discuss the strokes. (Cont)

I break it to my bro that dad has a very poor prognosis and that we should discuss next steps knowing that dad would have hated being stuck on a vent. My bro is in denial. He calls his MD friends who all say give it a few days. We decide to give my bro the time he needs to cope.

Sat, Nov 21st. -we tell mom. She doesn’t quite understand everything and holds on to hope that dad will wake up. We take the time over the next few days to let family/close friends pay their respects via WebEx. Many great stories. We decide as a family to withdraw care on Monday.

Mon, Nov 23rd - the worst day of my life ever.  I had called to nurse at 8:00 am to figure out the logistics.  They were only going to allow 4 of us to come into the hospital but we convinced them to let 5 of us in.  We hate that my SIL and BIL couldn’t see dad one last time.

The COVID ICU is like Fort Knox.  “You can only come in one at a time”.  How is mom going to do this alone?  The staff is kind enough to let mom be in the room while the siblings rotate.  When it’s my turn, I go in and sign the paperwork for withdrawal of care.

I go into the room, I lose it. I want to crawl into hole. I hold your hand and stroke your head. I tell you how much I love you, how much you meant to me, how you were the best daddy in the world and that God couldn’t have given me anyone better. I promise to take care of mom.

I promise to carry on your legacy. To always be smiling and to always help others like you did. To always look at the bright side of things, to never have hate in my heart. I thank you for everything you have done for me. The staff let my brother be in your room after extubation.

You passed within seconds.  It was clear you were ready to leave us.  I pray you didn’t feel anything.  I pray you weren’t scared.

Final thoughts: There were 3 diff. outcomes from these 3 cases. My SIL remained (-) throughout this. Why?  B/c she wore a mask the whole time. She wore it as soon as my parents returned from Florida.  To all the naysayers/non-believers, I hope you never have to go through this.

I am eternally heartbroken.  This was not fair to my dad who brought joy to those around him.  My parents were careful all year.  They wanted to support my aunt during her time of need.  That was always my dad’s priority.....his family.

We pleaded for them not to go but he always did things his way.  Dad, you lived a wonderful like and I know you had no regrets.  I love you!!! #WearAMask