Life and Death in Quarantine: Part 2

Finding inspiration at my favorite
local coffeeshop drive-through

At the beginning of the summer, when our nation and communities were struggling with a surge in COVID-19 cases as well as the aftermath of George Floyd's murder, I thought to myself, "This must be rock bottom for our country.  This is the collapse of humanity as we know it.  Things couldn't possibly get any worse for our nation right now."  That was before fires destroyed homes and lives along the west coast.  Before more cases of police brutality and abuses of power emerged.  Before the new school year started, with some areas virtually and some in person but all equally stressful.  Before the pandemic pushed people to their limits of mental health, causing our numbers of patients in the ICU with critical illness resulting from substance use and mental illness to reach unprecedented highs.  And before feminist icon Ruth Bader Ginsburg succumbed to cancer.  I'm still processing her death and what it means for women, for minorities, and for all humans in our country, and what it means for the future of democracy.  

Earlier this year I wrote about the death of my father-in-law and the ways in which the pandemic impacted his final months of life in the hospital as well as the family's ability to fully grieve his loss.  Shortly after his death, we lost my grandfather-in-law as well, who thankfully was able to celebrate his 100th birthday just weeks before everything closed down.  Over the summer I learned that one of my most influential high school teachers passed away from cancer.  Like many teachers, he was not just an instructor, but also a mentor and a friend who nurtured his students to reach their full potential and instilled confidence in them through his kindness and encouragement.  I still can't believe that he, or RBG, or any of my relatives who died during the pandemic, are really gone.  

I remember as a kid when one of my friend's parents was very sick with advanced cancer.  I hadn't seen this friend in a while, so when I saw her at a local restaurant, I was stunned by the frail and emaciated appearance of her normally vibrant and joyful mother.  It wasn't that she wasn't still beautiful, because I think her strength and courage reveal a different kind of beauty, but as a child with limited social awareness and underdeveloped emotional intelligence, I stopped and stared.  I was unable to hide my surprise.  I think I was even scared.  I had never looked death in the face like that.  Other people whom I knew had died had done so suddenly, or else they were already old and frail when I met them (like my great-grandmothers), so I never witnessed this transformation.  Even now, decades later, when I work around death and dying every day, I still remember this moment vividly.  I don't think a hospital is a place for children, and the lines and tubes are emotionally traumatizing for kids, but to witness disease progression and illness and eventual death is really important in understanding the circle of life and the natural human condition that is death.  I think this moment prepared me to witness the physical decline of my grandparents, whom I saw regularly but still witnessed their obvious frailty, lack of mobility, difficulty eating, and to be able to be present with that.

We have had many difficult deaths in acute care this year.  Individuals who were thriving and who suddenly take a turn for the worst.  Young adults with a new diagnosis who never make it out of the hospital.  Patients younger than myself dying of multiorgan failure from COVID-19.  People of all ages succumbing to the effects of mental illness and substance abuse exacerbated by the pandemic.  Situations when the medical team in collaboration with the family has to determine when the harm is outweighing the benefit.  Death is never easy, but the pandemic presents particular challenges around honoring the dignity of individual humans in the midst of death on a massive scale.  

Ady has been asking if people who die are dead forever, and also has a lot of questions about "everyone" dying.  I think it's so important to be honest and clear in our communication with kids, to not use euphemisms like "Grandpa passed away" or "Great-Grandpa is with the angels now," but to say the words "died" and "dead."  But I also want my children to learn that through stories and sharing memories, we can keep a person's life and legacy alive.  We can continue to discover more about a person's life through interactions with people who knew them.  Meredith never met her Grandpa Ross, and Ady will be too young to remember him, but we are now faced with the challenge and the opportunity of keeping his legacy alive.  I lost a teacher who was more that a teacher to me, but I am united with other students who were impacted by his kindness, and sharing our memories keeps him here with us.  On Friday night all lost an iconic and legendary figure who fought for equality and human rights, and now we are called to take action and fulfill her legacy.

So here we are in a pandemic, grappling with our own mortality.  We grieve the deaths of individuals, while also coping with the overwhelming masses of people dying daily.  We see that some people without comorbidities are dying, and even those who are surviving COVID-19 are left with chronic conditions and many unknowns.  But we also celebrate the beauty, I think.  We connect with people who understand.  We support each other and try to be a little kinder and a little more forgiving.  We share stories and memories.  While celebrate the happy moments in the midst of it all.  While working in the COVID unit last week, one of my patients celebrated her 77th birthday and was able to talk to her family on Zoom.  One of my ICU patients stood up for the first time in weeks.  And one of my familiar patients opted to transition to hospice care after a long battle with chronic conditions, which is the most compassionate and dignified path she can choose at this point.  The image of a "good death" is different for everyone, but there is a lot of dignity and courage in embracing the end of life and finding meaning.

I am so moved by these wildflowers
that insist on growing and thriving,
despite their rocky environment

Rest in power, RBG