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“Do you know how lucky you are?”
87 years old. Her face is tired and lined, her voice hoarse, her hair in need of a trim, her shoulders slumped. I sit across from her in her small one-bedroom apartment. Like most people her age, she has a number of illnesses that she and I keep in a careful balance. This allows her to stay out of hospital, to stay home, to stay functional.
It’s required intensive work from her and her family.
It’s required intensive work from me.
“Do you know how luck you are that you can just walk out that door?”
She looks longingly towards the door, her face sad. She lives in a retirement residence, which like most senior’s residences and nursing homes has been on lockdown to prevent outbreaks of COVID-19.
While the pandemic is in slow decline, the risk remains serious. The numbers from Ontario suggest that while most of the infection affected those in the 30-59 year old age group, most of the mortality has been among the elderly. This virus has a disproportionate impact on those who are older, more frail, and especially those who live in congregate care settings — communal living spaces like nursing homes, group homes and retirement residences.
But she knows all this.
She knows that the virus can be spread by people who have no symptoms or who have not yet developed symptoms. She knows that much of the virus is spread, person to person, among groups that have no travel history, among people who don’t know how they caught it.
She gets all this. These lockdown measures were instated to protect her and her neighbours.
“It’s my birthday,” she tells me, a wry smile flashing across her face. I sing to her and she laughs. I think of the brightly-coloured balloons dropped off by her son which the nurses have placed outside her door. He was not allowed inside to see her at all.
She tears up. She misses her son’s face. She misses her daughters. She enjoys her daily supervised walks, especially now that the weather is warm, but misses being able to pop out and sit in the sunshine with a neighbour for a cup of coffee.
“I’m hardly a social butterfly, but I am sick of staring at these four walls.” She gestures to the pale blue walls, “This is a slow death.”
Like many of my elderly patients, she has been focused on quality of life rather than quantity. We’ve talked about this many times in the past few years. She measures the value of her life in the number of good memories she can still make, not the number of years remaining to her.
And these days, her memories are of unremitting loneliness.
This pandemic has fundamentally changed the fabric of our lives from the way we say hello to how we work, live and play. It has crippled healthcare systems around the world. The international medical community, scientists, epidemiologists, public health officials and governments have all scrambled to understand, model, track and manage a completely novel disease. We have used dramatic containment measures to stop viral spread. No travel. No school. No parks. No businesses. No visitors in hospitals. No caregivers in nursing homes. Total and complete lockdown.
At the level of the individual, the person, at her level, the sacrifice she has made — been forced to make, really — has left her bereft and struggling.
In Ontario, we have managed to curb the disease. We think we know how, but we don’t really. We’ve only just begun to tease apart what works and doesn’t work with COVID-19.
What we do know: most pandemics have a first wave, followed by a second wave which is sometimes deadlier than the first. That’s what we saw with the 1918 Spanish flu pandemic.
So.
We have a window of opportunity to prepare. To fine-tune our approach. To map out how we will protect our loved ones, and especially, our most vulnerable.
She wipes away her tears. “I don’t have long to go, but this, this is more than I can bear.”
So we make a plan to get her through this. I’ll support her as best as I can. She stands by her door and waves goodbye. She looks beyond me to the sunlight spilling through the glass double doors of the retirement home.
Lockdown worked the first go around. But it cannot be the only tool in our toolbox. And it certainly cannot be the go-to measure in our COVID-19 pandemic plan. Like all medical treatments, lockdown has risks and benefits. And there is no doubt that lockdown has at times brought more harm than good.
My hope, my expectation, is that we use this time wisely to plan a phased, nuanced approach. So that next time we face down this virus, we do so without forcing people to sacrifice everything, and spend what could be their last few days sad, struggling and alone.