Choices, Opportunity and Living While You Can: Closes the Book for COVID-19

Carl was in his early 70s. A Vietnam veterinarian, he suffered from PTSD along with diabetes, high blood pressure and COPD caused by smoking. He would survive a period of kidney cancer, too, throughout his medical journey.

At the end of 2019 he came to see me because he was thinking of making a move to an assisted living facility. I thought it was a good idea as an older male with previous suicide attempts, I was worried that loneliness would add to his difficulties.

Carl had left his family. I knew he had an adult son and daughter, but he refused to talk about them, much less about them.

Assisted living would provide some communities in addition to three squares per day. The facility also had a nurse who could assist with medical care.

About a month after he was transferred there, the nurse called to tell me that she had taken Carl to the hospital for fever and shortness of breath. Its oxygen saturation had dropped below 90%.

This was in early March, when COVID-19 was still mainly in China and Italy. Our lives had not stopped. Still.

Carl was admitted to the ICU with “double pneumonia”. On chest X-rays, there was evidence of it in both lungs. It is not surprising for an older man with a long history of smoking, lung disease and diabetes.

Karl narrowly avoided intubation. With careful services, he turned the corner and was released back to his institution after a long hospital stay. A nasal swab turned positive for the flu. The flu had been the culprit!

His return to assisted life occurred just at the time the world was closing. All of our lives were changing dramatically.

Carl was quarantined at the facility. The nurse working there lived through March and April, until it was no longer feasible. She and the other staff did everything they could to keep their residents safe.

Before being hospitalized, Carl had come to my office every month. Helped alleviate his anxiety. Now that his facility was in blockage, our visits had to be made by phone.

I was surprised that he would survive the hospitalization, let alone that he had somehow missed getting COVID. His lungs were practically inflamed for this type of infection.

Throughout the spring, summer, and fall, Carl and I talked, sometimes every week. He was disappointed he could not go anywhere.

In one of the pandemic perversions, Carl started smoking again just so he could go outside to smoke a cigarette several times a day.

The happiest I heard throughout this year was when he discovered that he and some friends at this facility would be playing card games late at night with an assist from a friendly assistant who did not report them.

By the fall, there had been sporadic cases at his facility. He and his companions of letters returned to their rooms. He was not a happy camper.

All the while, I was afraid that Karl would eventually come out positive. He was at high risk and the care facilities for the elderly have acted as accelerators in the spread of COVID-19.

In December, it finally happened. Another fatal call from the nurse.

Carl was taken back to the hospital for fever and symptoms. He tested positive for COVID-19 this time.

Surprisingly, after a three-day observation, Carl was considered medically stable for discharge. He would have fever and pain without pulmonary involvement this time.

Due to the number of cases in his institution, he first had to go into isolation in a skilled nursing institution, used as a transition area between the patient’s land and the home.

While there on Saturday, he began to decompensate. His oxygen saturation dropped and he was taken back to the hospital.

I was able to talk to his nurse by the bedside, who told me he was struggling to breathe, but remained sober. I was able to go there in time to say goodbye.

Carl was in a COVID-specific unit that was commanded by the ‘regular’ use of the hospital due to the pandemic.

His nurse by the bed was visibly pregnant. “I already had COVID,” she told me.

Carl had clearly expressed his desire not to intubate or take ‘heroic’ measures in an attempt to prolong his life. He and I had talked a lot about him after being hospitalized.

Throughout the year the COVID spectrum was hanging over Carl. Above all of us. And now, with the imminent vaccines, his number was being called.

It was a cruel turn of fate and disease that will continue to be played over and over for at least most of 2021 as the pandemic continues its deadly march across America and most of the world.

I have no doubt that if Carl had been able to keep away from the coronavirus as long as he was vaccinated, he would have been happy to be immunized and have many more nights cards to look forward to.

As I stood next to his bed, Karl shook my hand and said, “Keep up the good work you are doing,” knowing it would be the last time we would talk.

He died a few hours later.

Just one of more than 343,000 Americans.

John Henning Schumann is a physician and writer in Tulsa, Okla. Ai pret StudioTulsa Medical Mondays on KWGS Tulsa Public Radio. Follow him on Twitter: @GlassH Hospital.

Copyright 2020 NPR To see more, visit https://www.npr.org.