For the last few months, two teddy bears have stood vigil on my nightstand. They are not my old childhood toys. In fact, their paths never intersected until they wound up there together, sometime in the gathering cold of early winter, but now that they’ve been united I could not separate them again.
The first bear is a slightly battered rendition of a panda. It isn’t special. I got it from IKEA a few years ago, partly because it was cheap — babe! It’s only five bucks! — but mostly because, after I’d plucked it out of a wire bin piled high with the same, I found myself strangely unable to toss it back in again.
It doesn’t have a name. Simply “Panda” will do fine.
I gave Panda to him on the second day. It was the only thing I had to give. He couldn’t hold it himself, not then, not with all the tubes twisting ribbons around his bed, so it slouched onto a shelf near the nurse’s window and cocked its jaunty head. It will watch over you for me, I told him. My whole heart goes with it. Even when I’m not here, you can look at it and know that I’m with you, together in spirit, never away from your side.
Panda did its job well. It watched until there was nothing left to see.
I don’t really know where I’m going with this story. It started as something else, and then it changed without warning. Maybe it just needs to be followed, and maybe you’ll come on that walk with me. It’s not like we’re going anywhere else of note, these days.
— — —
Earlier this week, The Walrus published one of the most elegant essays I’ve seen about the COVID-19 pandemic, written by a British Columbia physician who has worked through surges of critical respiratory illness. Author Kevin Patterson manages to connect all the key emotional and logistical beats of this pandemic in a single story: it’s truly a fantastic piece of writing. (I am sometimes slightly envious of professionals who are also brilliant writers: since writing is literally the only thing I’m any good at, it seems terribly unfair when others are good at, well, everything.)
The key part of that piece, as with almost any reporting on the pandemic, is where he describes the challenges of managing a surge in critically ill patients. One thing I’ve been thinking about this week, as I saw folks still expressing that they “didn’t see the big deal” about COVID-19, or that they deem the piecemeal shutdown of society to be “an overreaction,” is that part of this inability to understand what’s at stake is that most people don’t really understand what is involved in critical care medicine.
This isn’t surprising. To the general public, what happens inside the walls of a hospital is largely veiled from view. For the most part, we’re comfortable with that situation. We don’t want to think too much about the daily battles that play out there, the slow (or fast) unravelling of bodies, the fact that all of our scientific knowledge cannot always preserve the illusion that we are more than bone and flesh and fluid.
So some folks don’t think about what COVID-19 means for hospitals. They focus on the virus’s death rate, which experts estimate will settle somewhere between 1 and 3 per cent once more data is in: bad, but not catastrophic. They focus, albeit with increasingly quieter voices, on the fact that “the flu kills more.” They ignore thinking too deeply about what it means that around one in six people with COVID-19 require intensive care, including mechanical ventilation. It’s invisible to them, it’s another world, one that they don’t want to know.
I do know what it means, all too vividly, and I wish I didn’t.
— — —
The other bear does have a name: he is Pluto. My dad named him once, in the early 1940s, inspired by the floppy-eared Disney dog he would have seen on a flickering black-and-white TV. Dad loved his Pluto, loved most of the fur right off of him, loved him until his eyes fell out and his paws split open. My grandmother mended Pluto then, stitching him where he ruptured, leaving traces of her own love in lazy criss-crosses of silky brown thread.
As a girl, I loved Pluto too. He fascinated me because he was a survivor of time, the bridge between dad’s childhood and mine. In his button eyes, I saw the stories my dad always told about the halcyon days after the war, when America began to bloom in full colour, when boys read comic books and pulled Red Flyer wagons. He fascinated me because he meant the impossible: that my dad was once a child, just like me.
When I was nearing my teens, my dad, noting this connection, gave Pluto to me and, with a flourish, declared me to be the bear’s official guardian, which gave me great pride. For years, I kept him close to me every night, until my dad went through a difficult transition in his own life, when I gave Pluto back. The bear had comforted him once, I thought; maybe it could again. Maybe, if he looked into those button eyes, he too could see a time when every day stretched out as an adventure.
After everything was over, I asked for Pluto. He was the first and only thing I wanted.
— — —
In October 2019, my dad died of acute respiratory distress syndrome. Actually, that isn’t quite true. In the last days of his life, it was never entirely clear why his body, which just weeks earlier had been so strong for his age, was failing. All we knew is that everything inside him was either broken or breaking, and the doctors’ morning rounds had become a daily cascade of dread: the breathing is better today. (Good.) But he’s still not awake. (Bad.) We’ve noticed the swelling in his hands. (Us too.) The nurses are keeping an eye on it. (Okay.) We have to talk about what we found in the spleen. (Wait, his spleen now?)
So, better to say: my dad had ARDS. Then he died. It doesn’t really matter why.
To understand why the world is shutting down over COVID-19; why everything is cancelled; why social distancing must be our mantra; then we have to understand ARDS. It isn’t new. It’s what has always accounted for the majority of deaths due to respiratory infections, including the seasonal flu and, now, the novel coronavirus.
In short, ARDS is a type of respiratory failure triggered by any sort of lung damage. Infections are a common reason, but it can happen as a result of smoke inhalation or physical trauma. It can happen to people of any age, and it is deadly: up to half of people who develop ARDS will die. Those who survive often require months of rehabilitation, and even then they may never fully recover in body or in mind: ARDS can be so horrific to endure that many survivors are left with PTSD.
That’s true for families, too. For almost a month, my dad fought to survive ARDS and its many complications in the St. Boniface Hospital’s intensive care unit. Those weeks are the most traumatic of my life, and still cast such a haze of dread and horror in my mind that I can only conjure up the dimmest recollections of what they were like.
In those weeks, I learned far more than I ever wanted to know about respiratory failure. For the most part, those are the lost weeks of my own life, weeks devoured by the maw of some nothingness, devoid of anything resembling coherence; yet somehow, even buried in the fog that followed me everywhere I went, I did manage to take a few mental notes on the sheer effort of saving my dad.
— — —-
In a way, the first night in ICU was the hardest. Not for dad, but for me. He was sleeping then, drugged unconscious until they could slowly test to see if he could tolerate being awake on the ventilator. Not every patient can: for many, conscious ventilation is akin to torture.
For the first 30 minutes of my visit, I curled into a ball in the corner, back to the wall, trying harder than I’ve ever tried at anything in my life to make myself small. I didn’t want to be there, but I didn’t want to leave. I was too scared to approach his bed, too scared even to breathe, and terrified by the machines that wheezed and beeped.
I slipped outside, to the low desk where the nurse sat typing notes on her computer, glancing through the big window that overlooked dad’s room. When I tried to speak, my voice slunk out in a whisper.
“I’m having a lot of anxiety about leaving him,” I said. “Can you tell me what will happen overnight? What will it look like, each hour? What happens in an ICU?”
The nurse glanced up with a polite but distant smile, and began to explain.
This is how I first learned what I would soon come to see of the resources that were dedicated to him — no, not just dedicated, but devoted to him. This is how I learned that there would always be a nurse watching my dad, one-to-one care, with a team of other nurses standing by to help if needed. The line between his life and death was only as thick as their attention, and for this fact alone, even though I promptly forgot most of their names, I came to love them as fiercely as I have any person.
And this is how I learned about the circle of doctors who would wheel up to his room during twice-daily rounds; in the haze, I never really registered what all specialties were represented amongst them, but it was humbling to see the brightness of all that knowledge focused on my dad. This is how I learned about the physiotherapists who would come to try and preserve his strength even as he was fighting for his life.
Then there were the respiratory therapists. I learned about them firsthand.
It was that first night, when dad was sleeping. As I huddled in the corner, an alarm started screaming, causing our nurse to scrutinize the monitors with a frown. She slipped out of the room for a moment, and came back with someone else in tow, a twentysomething man with a short blond beard and a breezy demeanour.
“Lessee what we have here,” he said, in a reassuringly casual tone.
He punched in a few changes to the ventilator settings. Then, for what felt like forever, he stood silent over my dad’s sleeping body, watching my dad’s chest rise and fall in strange and shuddering breaths. The respiratory therapist turned back to the machine and made a few more tweaks; as he did, the alarm subsided. The numbers on the screen stabilized, and my dad’s chest fell into a calmer rhythm too. The man smiled.
“See, there,” he said, and I only caught fragments of what he said to the nurse next. “Just needed to… he was working so hard… gotta keep it in time with…”
Suddenly, a voice rang over the intercom: code blue. The respiratory therapist jerked his head up, dropped his clipboard on dad’s bedside table with a clatter, and wheeled on the heels of his sneakers as he dashed out the door.
“Oop, gotta go,” he said, calmly, and then he was gone.
He came back to fiddle with dad’s ventilator again, about 30 minutes later. I didn’t ask what had happened. He wouldn’t have told me, and anyway, I’d already realized that the golden rule of making it through a loved one’s time in ICU is that you really don’t want to know too much about what’s going on in the other rooms.
When you’ve already seen too much of what happens inside a hospital, it’s okay for the rest of it to be invisible.
—- —- —-
This isn’t the all of what it took to try and save dad, or even a fraction: I’m missing the endless and daily tests, the surgical consults, the constant addition or subtraction of medication. But it does, I hope, give a sense of what must understand at this particular juncture: a single patient who develops ARDS as a result of a respiratory infection can require weeks, even months of this kind of sustained, intensive and constant care.
Meanwhile, the health care system in Canada, and many other countries, is calibrated to absorb what it must, which is the usual seasonal ebbs and flows of patients. These resources can be strained even without a new pandemic: during unusually bad flu seasons, for instance, Manitoba Health sometimes sounds an alarm about the load.
What our health care system simply cannot do is absorb a sudden skyrocketing number of patients needing the same ICU resources my dad received, including mechanical ventilation. For one thing, ventilators themselves are limited, and we cannot materialize more out of thin air. Nor can we snap our fingers and create the human resources needed to keep them running. We cannot quickly summon more ICU-trained nurses, more critical care doctors, or more respiratory therapists who can fiddle with settings as they watch straining chests rise and fall.
In the long run, when all of this is over, I just hope that the experience of COVID-19 launches an entirely new dialogue about strengthening the public health care system. The greatest tragedy of all would be to go through all of this, and emerge no better prepared than we were before.
— — —
The bears are all I have of dad’s life, at the end.
Well, the bears, and fold of notes he’d scribbled, back when he was woozy from the fentanyl and couldn’t speak for the ventilator; I still haven’t had the heart to read them. I took no photographs in the hospital, except one: it was the night dad went to the emergency room, when we were concerned but not overly so. In the photo, a nurse is laughing as she fiddles with a machine. Dad’s face is covered by an oxygen mask, but you can see that his eyes are crinkled in mirth and his cheeks are flexed into a grin.
I took that photo to send to my siblings, so that they could see he was still in good spirits. “Here’s dad, making friends with the nurses, of course,” I wrote, or something close to that. (As with the scribbled notes, I cannot yet look at those texts.) That was the last picture I took of my father. As far as I know, nobody else took a photo of him after that night either, so that is where the photographic record of my dad’s life ends.
Which means that the last journey I took with my dad survives only in my mind. There are no photos, no coherent essays, no evidentiary trail of any kind. All I have are my memories, fragmented by grief but etched by the awareness that someday it would be important to for me remember what I had seen. Memories of tubes and machines, of love and of grief, and of a multitude of people who fought each day to save my dad.
All I have are my memories, and two teddy bears nestled together on my bedside table. One of them tended the beginning of a life, and the other watched over its end: now, they rest against a wall and lean their heads together, bound by the invisible stitches of the most beautiful sort of thread.