In August 2022 I was in Lisbon enjoying what I thought was a post pandemic revival of life. Every day there would be a concert, a comedy show, a meetup, or some other cool event to enjoy. Life had returned to normal and it felt so good to be back in the midst of people again.
On 9th August I got a phone call from my mom. She couldn’t talk, she was coughing uncontrollably. She hung up. Then I got a text from her: “I’m bad, can you come?”
My father had passed away from lung disease around 10 years ago. My older brother is 100% disabled with severe cerebral palsy. So he’s a 42 year old man who stays in bed, needs to be fed, needs to be bathed, and needs to be cared for 24×7. He lives with my mom in New Delhi. That’s my family, all of it.
I called her neighbor and asked her to take my mom to the nearest hospital: Manipal Hospital Dwarka, New Delhi. I also rang up my cousin who lives in New Delhi and asked him to go see what’s happening.
I was so nervous. This was my worst nightmare coming to life. My mother getting seriously ill while I was 8000kms away. My brother, entirely dependent on her care, left all alone at home.
At the same time I was also worried about what I would do with Leila. I asked Daniela if she could watch her while I go to India. She agreed and I was so grateful that Leila would be taken care of at home by someone who really loved her.
In the meantime I started looking for flights to go to India. Unfortunately due to the pandemic flight frequencies had dropped a lot. So I could only find flights that were expensive, with extremely long connections, or even overnight layovers. Eventually I found a flight with Lufthansa that would leave Lisbon the next morning at 5AM and get me to Delhi late at night. I booked it! A few hours later when I tried to check-in I couldn’t check in. I called up Lufthansa and they said that due to a strike in Munich, my flight wouldn’t get there on time so there’s no point checking in. They offered to rebook me on a flight 3 days later. I explained the situation to them and the guy on the phone was really helpful. He managed to book me on a flight through Frankfurt with a very similar arrival time in New Delhi.
While all this was going on, my mother had reached the emergency department at the hospital. She was temporarily placed on a BIPAP machine as her oxygen saturation was at 88% on room air. My mom has asthma so I thought it could be an asthma attack.
As I was transiting through Frankfurt airport on my way to New Delhi, my cousin reported that my mom had tested positive for COVID-19. Given her condition, they immediately admitted her to the COVID-19 ICU on the 5th floor of the hospital. I was relieved! She had been vaccinated against COVID so I figured that in 7-8 days she would be fine. In the meantime I’ll go to Delhi and take care of my brother. Phew!
I arrived in Delhi and the first one to greet me at home was Buddy, my mom’s dog. He ran out of the bedroom to the door and wagged in relief, “Oh you’re here, they took mom away! Bring her back!”. My brother was already asleep since it was about 5am.
You’re not allowed to visit patients in the COVID ICU. So I couldn’t really go and meet my mother. They did have a way to video call the patients in there, so twice a day I could call my mom and chat with her for about five minutes. But, as the days went by, she didn’t want to talk as much. In the first few days she would ask about my brother, about me, but as the days went by she was struggling more and more to breathe. They had her on empirical antibiotics, low dose steroids, and some vitamin supplements. I didn’t know exactly what she was taking because I couldn’t visit the ICU and look at her charts.
I was all alone at home, waiting for news. Well I had my brother and the dog there, neither of whom could talk. I reached out to a friend and said I’m all by myself, I’m really struggling. He got on a plane from Bangalore to Delhi and came and spent a week here with me!
One night I got a call saying that my mom had become hypercapnic and passed out. This is when the calls started.
This is also when I started going down the rabbit hole of ICU terminology. They said they had to put her on Non-Invasive Ventilation (NIV) support. They use NIV and BiPAP interchangeably when they talk to you. So you need to know what they are talking about. It’s a mask that’s fit tightly around your face and the machine provides oxygenated air at a higher pressure than normal. This opens up your lungs and helps you breathe better. At that time my mom was on 40% oxygen. Normal air contains 21% oxygen. Not too bad, I thought.
Also, what does hypercapnic mean? Nobody tells me anything! When I get a call from the ICU in the middle of the night I fear the worst. When the doctor rattles off some jargon my first thought is: Is my mom going to be okay? So it sounds like a stream of words and the emotions sweep me away. I have no idea what to make of it. I don’t even think to ask the doctor to explain what he meant, besides, he’s already hung up after stating ominously: “She’s stable, for now”.
I wonder how people managed before the days of Google. I quickly found out that hypercapnic means you have too much carbon dioxide in your blood. Your lungs perform two functions, deliver oxygen and remove carbon dioxide from your blood. This is where things get complicated. When lungs fail, it’s fairly easy to provide supplemental oxygen, just increase the amount of oxygen the patient is breathing through a mask.
But how are you going to get that carbon dioxide out if the lungs aren’t pulling their weight? Enter positive pressure ventilation. Without getting into too much detail, the positive pressure in the pipes, mask, machine, and your lungs is maintained even after you exhale. This keeps your lungs inflated and your alveoli ‘recruited’. Alveoli are the small sacs in your lungs that help exchange oxygen and carbon dioxide with the blood. With positive pressure ventilation, the pressure during inhalation is higher than exhalation but both pressures are higher than atmospheric pressure. This keeps your lungs open and helps with carbon dioxide removal. How do I know? Believe me, I had enough time to read about all of this and understand what was going on. I also had the motivation that only life or death circumstances can force one to have.
In fact, I got to learn that one of the primary objectives of ventilation is to ventilate which actually means to remove CO2. I had to learn about ventilation and perfusion at some point. I had to learn about which parts of the lungs do what. But we’ll get to all of that in a hot minute.
She was stable, for now.
Following this, I could never really chat with her over video call because she would put the tablet down as she was always struggling to breathe. So I did what I could do. I took care of my brother, I took care of Buddy, and I waited. What added to my woes however was that my brother was refusing to eat and the dog was bringing in ticks every single day. At one point I removed about 30 ticks from his body. So eventually I decided to take him to the vet. The vet wanted to shave his fur and I told the vet that if we did that my mom would have a heart attack when she came home. Instead I took him for a bath and vigilantly watched for ticks every day and sprayed his paws with tick repellent spray everyday. My brother fussed with his food for about 10 days and eventually started eating again. But for a moment there I felt like everyone was trying to do me in, by doing themselves in.
One night I felt really anxious. I hadn’t been able to talk to my mom so I went to the hospital at around 10pm. Luckily it was easy for me to go to the hospital, it took around 8 minutes for me to go from the front door of my house to the door of the ICU on the 5th floor of the hospital. I knocked on the ICU door and asked if someone could tell me how my mom was doing. A doctor who was on duty came outside. He looked at me and said she was doing okay but if she gets worse they will need to intubate. Now, for those who are not fans of medical drama on television that means if she gets worse, they will need to put her on a ventilator. ‘Intubate’ because they shove a bunch of pipes down your throat, sedate you heavily so you don’t gag and use the ventilator to help you breathe. They also paralyze you in this process and the heavy sedation is also so that you are not terrified that you are unable to move. The paralysis is to reduce ventilator-patient asynchrony. That is, when a person tries to breathe on their own and the ventilator is trying to provide breaths at a different volume or rhythm. It all sounds absolutely horrifying but these are all measures that are used to save people’s lives.
The doctor was kind and asked me if I had seen her yet and if I had come from abroad. When I told him that I hadn’t seen her he asked me if I wanted to. Now, I’ve had Covid twice and been vaccinated and boosted recently. I wasn’t too concerned so I said I would love to see her. He made me put on a bunch of personal protective equipment, double masks, etc. and let me in to see her.
She was lying there exhausted, struggling to breathe with this tight mask fitted to her face and forehead. She saw me and I’m not sure if she realized we were party to a protocol violation. I stood there for a long time caressing her hands and telling her it’s going to be alright. Before I left I told her that I loved her. It’s not something we say a lot in our family but it felt like the right moment to say it.
After 7 days, as per protocol she was discharged to the normal ICU. I was happy that I got to go at visiting hours and see her. On Day 8 I cheerfully entered the ICU to boost her morale. But she was barely cognizant of the fact that I had come to see her. She was struggling to breathe with the mask and kept asking me for a nebulizer. I tried to encourage her a bit and say that she was going to be alright. I spoke to the doctor who said that she was doing alright, for now. They said “Of course, she has bronchial asthma so that’s a bit of a complication.” I had to start getting used to hearing this.
The doctor also said that she seems to need a lot of oxygen. They expected that her lungs would be clear by now. She was on a nasal cannula with about 5L of oxygen per minute. He said they were alternating between BiPAP and the nasal cannula but she was struggling a bit. So he said perhaps we should do a CT scan just to see what the situation is. I agreed and said please do whatever you need to.
I felt that now that she was out of the Covid ICU it was just a matter of recovering for a few more days. I could go and see her twice a day, boost her morale and she would soon be discharged to the general ward and on her way home.
But the nightmare had just begun.
