‘Goodbye, Mum. I love you.’
There are 18 Kiwis who have died of coronavirus in New Zealand. Each one leaves behind a grieving family and heartbroken friends. Here, in a moving diary, a son recalls his mother’s last days of hope and sorrow as she is lost to Covid-19
Thursday
There have already been news reports of confirmed Covid-19 cases at the rest home. My mother, who is nearly 80, has been a resident for a few months.
Around midday I'm rung by the manager. Her tone is positive, and she gets to the point. Mum has the virus, but like most of the residents her symptoms are mild. She had a temperature spike on Wednesday but today it’s normal. She has a cough, but no shortness of breath. The DHB has brought in extra staff to help look after infected patients. I feel okay with the news; Mum is frail and has underlying health issues but if her symptoms remain mild and she is well looked after she should get through. I tell my wife and call my brother. We're concerned, naturally, but accept we can't do anything, considering we are in our own lockdown bubbles and the rest home is closed to visitors.
Friday
I get a call mid-afternoon from someone at the rest home, a ring-in from another facility called in to help. The decision has been made to move Mum, and a few others, to hospital that afternoon. The reason given is that the DHB nurses and doctors feel they can look after them better in the hospital environment. Later in the news report I read, the reason given is that the rest home is understaffed due to virus-related stand-downs, so the infected residents will be moved until staffing levels return to normal. Conflicting explanations, but it all seems reasonable. Mum's condition is unchanged. It's time to tell the children, Mum's only grandkids, she has Covid-19. They take it well. I guess her history of health issues has prepared them for it.
My cousin sends me a link to a breaking news story about ambulances at Mum's rest home. Now we have to tell the wider family. Best wishes, prayers and positive thoughts flood in. It's a surreal feeling to be caught up in the biggest story in the world, especially in New Zealand where the narrative to that story is so positive. I hate this plot twist.
Saturday - Monday
My wife and brother take turns contacting the hospital to check on Mum. Nothing has changed. My wife's keen to organise a way to talk to Mum, but she's told it's practically difficult.
Tuesday
Around midday, I get a call from the charge nurse on Mum's ward, who hands the phone to a gerontologist who has been caring for Mum since she was diagnosed. He wants to update me on her condition, but also to warn and reassure me, because it is to be announced at the 1pm press conference that a woman in her 70s, a rest- home resident, died in hospital the day before. I alert my wife, brother and extended family.
At this point there is no nationwide policy on compassionate visitation rights for families. The doctor says one person from the family can come, for brief visits, but it must be the same person each time. After talking to my brother, we decide it will be me.
Later in the afternoon, when I contact the charge nurse to arrange a time, she checks further up the decision-making chain to see if I am allowed to visit Mum. The answer, thankfully, is yes. Later, I read on the Ministry of Health website that each DHB makes its own policy on the conditions under which visitors may enter hospitals during the lockdown. I feel I understand the risks. I've been the one in our bubble doing the supermarket shopping. Last week I had an extreme runny nose and the sneezes and the helpful Heathline person suggested a test would be sensible; I had the uncomfortable nasal swab on Friday and the negative result less than a day later.
Heading along the motorway is the furthest I've driven in a month. I stop at the supermarket to get Mum some treats I hope will tempt her to eat and drink: Lucozade, juice cartons, chocolate bars, biscuits.
There's a security guard at the main entrance to the hospital, plus a staff member behind a desk, who has my name on a list. I stand behind a line taped on the floor and answer questions about symptoms, overseas travel and contact with known or probable cases. It's a “no” to all the questions. I tell her about my negative test result. The staff member fits me with a white wristband. I'm directed through to the hospital lobby and the hand sanitiser, then told to sign in by the inquiry desk — name, phone number, email, name of patient, ward, time of visit, yes/no Covid questions, signature. I've visited Mum here many times in recent years. At the ward. I'm let in by the duty manager, then met by the charge nurse and the gerontologist. The doctor is much more concerned about Mum now, at 5.30pm, than he was at 12.30pm. She's not getting enough oxygen, so they have begun to give it to her through a nasal canula. He uses the word “succumb” and I start to realise the extent of the slide in Mum's condition since the first call I got from the resthome manager last Thursday. The plan is to move Mum tonight to a room where they can boost the concentration of oxygen to help expand her lungs. I ask if this is ICU — I've read of how few people survive once they need intensive care — but the doctor and charge nurse quickly tell me no.
I sign another register, in front of another security guard, before we can enter the closed corridor where Mum's room is. The charge nurse stops outside the room and begins to explain the process of donning the personal protective equipment (PPE), all neatly laid out on a high shelf by the door. First is the gown — light, waxy, yellow. Next are the rubber gloves, blue and large. When I've finished, these come off first, hooked
carefully from the inside. Then I get a white mask, and last is a thin plastic eye shield which goes over my glasses. I've never worn anything like this. It's disconcerting.
The charge nurse, who is calm and reassuring, asks me if I'm ready, and opens the door.
Mum is the only patient in a fourbed room. She's in the bed by the window to my right. Her nurse is seated and is helping her eat a pink pudding and sip a fortified drink. The rest of her dinner, including soup and a beef stew, is untouched.
This is the first time I've seen her since the day before the lockdown, when I took my children to see her through the window of her room at the rest home. She looks tired. Her breathing is quite fast. She is pale. But she recognises me despite the PPE get-up and responds to my greetings. The nurse finishes with the food and leaves us alone.
It's quiet. I can hear the ticking clock behind me on the wall. Every now and then a box at the foot of the bed makes a pumping noise. I can hear my own breathing in the warm mask. I can hear the rattling in Mum's chest.
I'm not sure how far away I should sit, or if I should touch her, so I decide to sit where I normally would, nearer the foot of the bed, and don't make physical contact. After telling Mum everyone is thinking about her and sending their best wishes, I struggle to know what to say. Mum fidgets and slips into a lean. I ask if she needs more pillows or something, and she nods. After pushing the call bell, a care assistant comes in. Then Mum says she feels sick. I stand and adjust her sheets, even though I'm concerned for myself at getting so close. I notice there is a small gap of exposed skin between my glove and the cuff of my gown. Mum's nausea has passed.
The care assistant leaves Mum and me alone again. I mention specific people who have sent her messages of support. She listens, but in the silences closes her eyes and her head drops. No one seems to be in a hurry to have me leave, despite the gerontologist telling me I should only make brief visits. I've been here nearly three quarters of an hour. Mum is done in, and so am I. I promise I'll be back tomorrow. I tell her I love her. “I love you too,” she replies.
Removing the PPE is done in the room’s bathroom. I have to concentrate to remember the right order of removal. Gloves, sanitise, gown, sanitise, eye shield, sanitise, mask, wash hands. The duty manager confirms the plan to move Mum tonight. I leave the hospital via the main entrance. I drive home in the dark, unsure what I should be feeling. I'm hoping for positive news in the morning and signs of improvement with the step up in treatment, while at the same time I'm dreading a phone call in the middle of the night. At home I leave my shoes outside, strip off my clothes in the laundry and throw them in the washing machine, then I shower. At dinner I have to tell my children their Nana is worse today.
Wednesday
There was no call in the night. I'm awake early and do a couple of hours work before I confirm with the hospital that I'll be in around lunchtime.
Mum is in a new ward, connected to the previous ward. While I wait for the charge nurse, the same one is responsible for both wards, a doctor I've not seen before approaches me. She holds a stapled sheaf of papers scrawled with notes.
This doctor has been looking after Mum. Her words are serious and pointed. It's confirmed Mum has pneumonia. She is on IV antibiotics as a precaution against bacterial infection in her lungs. They are giving her additional fluids subcutaneously. She is on a higher concentration of oxygen in the new room, but this has not increased her oxygen levels.
I ask about the plan from here, hoping for a glimmer of good news. There is definitely no plan for ICU — ventilators, intubation, etc, would be too brutal on Mum given her general state of health. Knowing Mum's underlying conditions, I can understand this clinical, and compassionate, decision.
There is scope to increase the amount of oxygen she receives. Beyond that, the doctor says, it's measures to make her “comfortable”. That's it. We all know there's no pharmaceutical treatments for this novel coronavirus. I now know Mum's chances of beating this are minimal.
I ask the doctor how things are likely to go from here and she says
I can hear my own breathing in the warm mask. I can hear the rattling in Mum's chest.
the disease seems to progress quite slowly so it would probably be “days”. Days. Damn. I don't want to be here. Not on my own. Selfishly, I feel trapped, committed to coming here alone every day to watch helplessly as my mother ebbs away. The doctor leaves me in the corridor and I call my wife, desperate for comfort and connection.
She is calm and sympathetic. She says to ask if the palliative-care team will be involved. I call my brother and he accepts the gloomy update well; we've had a few similar conversations in recent years about her health.
The charge nurse is back on the ward; there has been a change in the conditions of my visitation rights. I must speak with an infectiousdiseases physician who will outline the risks to me of my contact with Mum. And I must sign a consent form acknowledging the risks have been explained and I accept them. This seems sensible, even if it's 24 hours after my first contact.
The consultation with the infectious-diseases doctor is over the phone and thorough. He screens me and is happy with my general health and lack of underlying conditions. He says the PPE is very effective if worn, and removed, correctly and the chances of transmission negligible. This, he explains, means I will be defined as a casual contact rather than a close contact.
Finally, the doctor tells me I don't need to launder the clothes or shoes I'm wearing to the hospital before I re-enter my bubble, and I don't need to shower, or isolate myself from my bubble mates any more than normal. I do need to continue to wash my hands thoroughly and maintain good hand hygiene. And I need to get a test if I show any of the known symptoms. I thank the doctor and hand the phone back to the charge nurse. She hands me the consent form to read and sign.
I ask the nurse about palliative care. I tell her what the specialist told me about the disease's slow progression. She says it can progress slowly, but it can also be quick. This contrary information is not a surprise; clinicians' experience and understanding of this new affliction is bound to have wide variance. The charge nurse finds another doctor, a more junior one this time, to answer my question.
This doctor meets me outside Mum's room. Through two windows and an ante room I can see Mum in her bed. The doctor is in scrubs. Her Irish accent is soothing as she explains that the palliative-care team will be consulted, if needed, and painrelieving options are available.
Mum's nurse appears and leads me into the ante room where I will dress again in the protective equipment. I enter the room proper alone. This is a single room and it comes with the big bonus of a television, up on the wall. Mum's a big TV watcher. There's some British real estate show on.
Mum is awake, sitting up. She turns from the telly and I say hello. She looks at least as good as she did yesterday and maybe not so tired. I get out my phone, safe in its plastic bag, and I show her pictures of the kids and some from one of her siblings. I play a video message from my brother. Mum watches with interest. Then I notice she's changed the channel on the TV.
There's Prime Minister Jacinda and director general Ashley giving their live 1pm press conference, updating the latest Covid-19 statistics. The sound on the telly is low, but the numbers flash in red across the screen. A few new cases. A couple of deaths. Eleven people in hospital. Well, Mum, I say, how does it feel to be famous? She smiles. Even in the grimmest moments, humour has a place.
I ask about lunch, trying to distract her from the only news in town. Yes, she ate something. I'm running out of things to say, as usual. I tell her the thoughts of everyone are filled with her right now. She smiles and nods. “Goodbye, Mum. I love you.”
“I love you too.”
I'm more confident with stripping off the protective gear, but still apprehensive not to stuff it up. There are no dramas, from sweaty gloves to stuffy mask. But out on the ward there's another condition to my visitation rights: I must leave my contact details, to be given to the Auckland regional public health service. They will contact me every day to check on my health. That's reassuring but also cause for reflection on the risk I'm taking.
It's a beautiful autumn afternoon as I drive home. The Waitemata glistens, and the Harbour Bridge's coat-hanger profile aligns exactly with the outline of Rangitoto. A gorgeous and familiar view, dulled by the realisation I will probably be the last family member Mum ever sees.
An hour later I get my first call from public health. Any symptoms? No. Any issues with the PPE? No. Any questions? Not at this stage, thanks. Efficient, reassuring.
Over dinner I tell my family Nana is looking okay, that she's about the same as when I saw her yesterday. Steady as she goes. Good old Nana.
Thursday
I ring the ward about 9.30am but they are busy. The physician eventually rings me back, the matter-of-fact one from yesterday. Mum's situation is still not good; the “crackling” is now in both lungs. Her oxygen saturation is still around 88-91 per cent but was as low as 87-88 per cent overnight, that's despite her being on a higher concentration of supplementary oxygen than yesterday. She doesn't have a fever. Her blood pressure and heart rate are good but her breaths per minute are 20-30, whereas most people do 15-18. She is on IV antibiotics as a precaution against a bacterial infection joining in the party started by the virus. I ask what future treatment options are being considered.
“We can increase the oxygen concentration. Otherwise we are looking at comfort measures, such as morphine, if your mother becomes distressed.”
Later, I rationalise the doctor's gloomy outlook: Mum just doesn't have the physical reserves of energy for this vicious fight. I thank the doctor for her time and end the call.
I update my brother and my wife: Mum's survived another night, she's pretty much the same, we wait to see what will happen.
No form to fill in today at the main entrance of the hospital. It's around 12.45pm and I see a lot of staff in the courtyard below, sitting together having lunch.
Downstairs in the ward the admin assistant calls a nurse to let me into the restricted corridor; Mum is in the first room. Her nurse greets me and takes me into the ante room. Mum has had a good lunch, for her — a fortified drink and a carton of juice, one of the apple and blackcurrant ones I'd got for her on the first day of visiting.
Mum is awake, propped up and watching Emmerdale on the telly, with the sound low. She knows it's me under the protective gear and has no trouble hearing and understanding me through the mask. Her breathing is rapid, but she's not breathless. I can't hear any chest “rattles”, which I could in the quieter room on the first day I visited. Not much is happening at home under lockdown but I offer what news there is: one grandchild is back into the schoolwork; another cooked Swedish meatballs for dinner; there's still no sport to watch. Mum listens, and hears, but is distracted by the telly, so I call my brother and Mum has a video chat with him for a few minutes. This is the first time they've “seen” each other since before lockdown began. My brother is keen for Mum to get better so she can go to see the house he and his wife are having built. She waves and nods, tries to answer a question, but loses her train of thought. The telly is still holding her attention. As I end the call, Mum flips the TV channel to the live 1pm Covid-19 press conference. I resolve to visit at a different time tomorrow.
Less than a handful of new cases: good news. More deaths: sobering news not to be dwelt on. I ask Mum if she wants a Moro bar (another treat I'd brought in). She's not really bothered but I get one out and she holds it for a moment before I put it on her tray.
I'm ready to go. Mum gives a half cough. I check she has the call bell. I tell her I’ll be back tomorrow. And I tell her I love her.
In the ante room I disrobe alone. I glance in at Mum, but she is focussed on the TV. I leave the ward and hospital quickly.
At home I strip and shower, wash my clothes, despite it not being required. The family is updated via email, Messenger, WhatsApp, text. At 2.30pm public health make their daily call. No, I have no coughs, fever, shortness of breath. No, there were no issues with my protective gear.
Yes, I’m planning to visit again tomorrow. The doctor asks how Mum is and I tell him she is okay.
Later, I tell my children Nana is about the same as yesterday, which is true, although I’m more concerned than I was yesterday.
It’s hard to turn my mind to productive endeavours. I watch some TV and read some outraged tweets — are there any other kind? I worry about getting infected and passing on this deadly disease to the other cherished people in my bubble. Still worried, I make vege soup for dinner. At the table, talk is not about Covid-19, or Nana, but two hours later I can’t recall what is was about.
Friday
It’s a beautiful day for ugly news.
I go in to visit Mum earlier today so she can video chat with a relative overseas. Her nurse meets me in the ward and gives an update. Mum has been very restless during the night, trying to get out of bed, removing her nasal canula. She didn’t want breakfast. The nurse didn’t give her any morning medications as she was concerned about choking. I’m helped into the PPE. Okay.
Mum is watching whatever’s on TV — the home-schooling channel, it looks like. There’s a big change in her. There’s no spark in her eyes. She says barely a word when I talk. I connect her to a live video chat with her relative, who she recognises. There’s a brief smile, but no words. I end the call quickly. I need to give my wife and my brother a chance to speak to Mum. That’s another two quick video calls, a look of recognition in each, but no response. Mum is agitated. She’s thirsty, she says. But it’s too difficult for her to suck up a sip of water.
I’m so worried by what I’m seeing. I have to get out so I can talk to Mum’s doctor. I say goodbye and there’s an acknowledgement from her. But then I see the doctor is gearing up to come in. She says hello then examines Mum. The stethoscope is cold and Mum reacts, eliciting an apology from the doctor. The doctor asks me if Mum has told me how she’s feeling, if she is in discomfort. No, I say, but I haven’t actually asked her. I wonder if that’s callousness on my part.
I follow the doctor out and we doff our PPE together. In the doctor’s office we sit.
Mum is getting the maximum oxygen they can give her, but her own oxygen levels are slipping. She’s breathing fast and hard to compensate but it’s not enough and it’s tiring her out. The viral count is going up and up. The pneumonia is throughout both lungs. The doctor, an experienced intensive-care specialist, says someone like Mum cannot survive once the situation gets this serious. Intensive care is not a realistic option: in ICU, a fit 40-yearold would still have a very poor chance of recovery at this stage.
We make the decision together. The focus of Mum’s care will now be to make her comfortable. This will involve the palliative-care team who will help manage any discomfort and ensure she remains pain-free. She’ll go back onto a lower level of
supplementary oxygen. This will mean she will become less responsive and less aware of her surroundings. Her distress may increase, hence the need for active pain management. There’s no talk of a timeframe for this final stage. I hope it’s quick and painless. I wish I didn’t have to think about this.
I can’t remember if I told Mum I loved her before I left her for the last time.
And it will be the last time. I don’t want to risk my health when I can’t help or comfort to her. I can’t justify the risk, small as it is, of transmitting shitty Covid-19 to my wife and children.
I feel enormous gratitude for the people caring for Mum. I’m filled with the dread of telling my children their Nana is going to die.
I leave the ward, exit the hospital, drive home in the sunshine. A beautiful day for ugly news.
Strip, laundry, shower, hug from my wife. A call to my brother with the grim details. Then tell my children. Sobs, hugs, acceptance.
Breaking news at 1pm: A few new cases, one death. Eight in hospital. There’s no humour to be found here now. 2.30pm. Mum’s nurse rings to tell me the palliative care has started. Mum has a syringe driver administering pain relief subcutaneously. They are about to remove her from the highly concentrated oxygen supply. But she won’t be moved from the special room until they see how quickly her condition changes. I’m really hoping the virus finishes its cruelty with all haste. 5.25pm. The charge nurse calls. Mum died five minutes ago. They took her off the oxygen and she quietly and painlessly slipped away over a few hours. Mercy. Relief. Tears and sorrow. Last Friday, another caller was reassuring me Mum’s transfer to hospital was temporary, that her symptoms were mild. It feels like a week in the eye of the biggest storm.
It will soon be Anzac Day, lest we forget. I’m not making any war analogies. The tragedy of this pandemic is its own horror. We are beating it back, confident in our united effort. It is swinging hard and lethal in return and every victim is a cherished one, taken too soon. I love you Mum.