My mom just passed away. I’d been caring for her around the clock in home hospice for close to a month. Three weeks before I arrived, she was discharged from the hospital following a two-week stay for COVID. Although her death certificate says that she died from cardio-pulmonary arrest, she would almost certainly be here today if not for the COVID.
Prior to that, she was actively independent — quilting, reading, following the news, driving, balancing her checkbook and ordering from Amazon. At 82, she’d been on dialysis for a year and her memory was just starting to go. But when she came home from the hospital, she was confused and weak and barely able to walk on her own. She could no longer engage in any of the activities to which she’d been accustomed.
Thinking first that her infirmity after COVID would be temporary, we organized home care. Soon afterward though, she had a bad fall. It was then clear that mom needed someone with her around the clock. Nonetheless she spiked a fever two weeks after she came home, and wound up getting readmitted to the hospital. To my surprise, she elected to have a surgery, which resulted in her transfer to the intensive care unit.
After a long and hard fight, the family decided to withdraw care. My sisters and I went to the hospital to say our final goodbyes, but when her breathing tube was removed, mom began to sing. She was so incredibly grateful to still be alive. We children were utterly amazed, We brought her home and loved her up for her final 10 days in home hospice. The meds she received there were quite effective in taking the edge off of any pain or agitation and she ended up passing quite peacefully and gently.
Because so many of us feel awkward when wishing to comfort the survivors of someone who has passed, my father, Leonard, wrote a book, “The Art of Condolence, What to Write, What to Say, What to Do at a Time of Loss.” The gestures of empathy from family and friends have meant so much. Kind words from staff at Manakai O Malama and from fellow medical officers on the around the world voyage of Hokulea have been deeply consoling as well.
It is painfully sad that as a culture we have become so removed from death and so fearful of it, when death is as natural as birth itself. Having practiced medicine now for 30 years, and having cared for two of my grandparents and my father in much the same way as my mother, it has always been my experience that the end of life can come with a degree of ease, if it’s skillfully handled. For this reason, I have always opposed euthanasia, “death with dignity” and Hawaii’s “Our Care, Our Choice Act,” which was signed into law at the beginning of 2019. Although the majority of Hawaii residents are in favor of this new law, among the many people I have spoken with, the common sentiment is a fear of the loss of self-control.
What we can control is how we protect the people of Hawaii from yet a third COVID surge. Pre-travel testing set to begin on Oct. 15 will help reduce the chance of spread. Although testing 72 hours before flying will identify and prevent many of those with COVID from entering, there still will be too many visitors who develop COVID upon arrival to Hawaii either from exposure just prior to their pre-travel test or from exposure after testing and before arrival. If in addition to pre-travel testing, all arrivals quarantine for just four days and then get tested again, it will reduce the chances of a third surge beginning around Thanksgiving. A second test, on day four, challenges testing capacity and compliance of visitors. Still it would be a powerful adjunct to pre-travel testing alone and would be preferable to returning to a 14 day quarantine for all arrivals, especially if too many cases are seen to slip by.
Businesses are reeling, unemployment is untenable, families continue to suffer from food and shelter insecurity, our homeless population grows and government coffers continue to run dry. Every measure and each day we curtail business activity to mitigate the spread of COVID adds to this tremendous burden. However, any incomplete or premature loosening of restrictions that results in a third surge over the holidays will ensure that many more jobs and businesses in Hawaii will not return. At the same time, we will continue to lose our loved ones.
Ira “Kawika” Zunin, M.D., M.P.H., M.B.A., is a practicing physician. He is medical director of Manakai O Malama Integrative Healthcare Group and Rehabilitation Center. His column appears the first Saturday of every month. Please submit your questions to firstname.lastname@example.org.