(Note: For the sake of simplicity, I use Covid, Covid-19 and Corona Virus interchangeably in this post, with inputs from my friend and trusted doctor, Dr. Gaurav Sachdeva)
They say nothing teaches you lessons more than experiencing something first-hand. I certainly have learnt a few lessons in the past two weeks, and continue to even now, when three of us at home tested Covid positive.
I’m putting these lessons down here in the hope that they may be useful to you—whether you are an elderly person yourself, or you have an elderly person in the house, or you find yourself acquiring the Corona Virus yourself, or if and when you want to provide support to friends and family who may be affected by the illness too.
When Covid Strikes
My octogenarian Dad’s fever started on August 25th and continued for two days. It was prudent to get him tested for Covid-19, keeping in mind his age and co-morbidities. On 27th August, as I was getting ready to get to my sessions for the day, I got a call from Dad’s colleague, who is also the go-to person for our family’s medical needs. I knew why he was calling.
“Divya, your Dad tested positive, and I don’t know how to break the news to him,” he said with worry writ in his voice. He started discussing hospitalization options and I heard him out.
“But why admit him when his saturation is normal and his fever lasted only two days and he’s been afebrile for a day? He has no other symptoms?” I asked calmly.
“He MUST be admitted,” is all I was told. End of discussion.
He said he would be calling him next to break the news to him, and I went downstairs to be with Dad.
My Dad as expected, was anxious on hearing the news, and his mind galloped to the worst case scenario of the high mortality rate in people above 60 and with co-morbidities.
And then on started a slew of calls with a team of doctors who insisted Dad gets admitted. Some said it was a government directive that every person above the age of 60 MUST be admitted. I could only sense the fear in their voices, the worst case scenarios looming in everyone’s head. I got myself acquainted with the Ministry of Health’s guidelines for management of mild symptoms in the elderly.
This was Day 3 since the fever, and the fever had lasted only two days. No other symptoms except a lack of appetite. His SpO2 levels were a steady 97-98%.
We wanted to make an informed decision.
“What would the doctors treat symptomatically?”
“Can’t we get the tests done for him (most importantly inflammatory markers, D-dimer, IL-6, HRCT amongst others) and then take a call?
“My concern is a hospital acquired infection and the fact that he would be in isolation, which frankly can be quite traumatizing.” I know my Dad.
“I can manage him at home, take care of his nutrition, medications, be with him to support him. He can walk around in the quarantined portion of the home and breathe some fresh air. What would they do differently at the hospital?”
When Fear Strikes
These were my questions to the very well-meaning doctors. And their response was “What if his condition deteriorates?”
The “what if” questions are a strong indicator of anxiety in psychological terms. The mind starts predicting the most distressing outcomes, and conjures up catastrophizing images and thoughts and no answer can come close to reassuring us and alleviating the anxiety. The only option is to give in.
While all this debate was going on, we went and got Dad’s blood tests and the HRCT scan. The news was encouraging. His tests were within normal limits and the HRCT score indicated a very mild infection.
The debate persisted to still get him admitted. Another pulmonologist said “I wouldn’t bat an eyelid and have him admitted for observation.” The thing I didn’t get was that he wasn’t even at the hospital that we were considering for Dad.
I calmly told Dad that if he had the slightest doubt and wanted to get admitted then we would go for it, and the family together weighed the pros and cons.
In my heart I somehow wanted to buy another day so that his continued clinical stability could allay his colleagues’ and his fears.
My symptoms of a slight cold, and complete loss of smell and taste started the next day as Dad’s, but my attention was completely focused on him and so wasn’t in a rush to get tested. I knew I would test positive. Which I did the next day. I was actually relieved (how strange you may think!) because if Dad needed to get admitted then I could also be with him.
Dad continued to be stable but the debate to hospitalize him continued. We still sought the opinion of the pulmonologist who Dad would be admitted under, and he advised home management till the tests were repeated to see if there were marked changes in his inflammatory markers and HRCT four days later. I breathed easy, literally and psychologically.
SP, our man Friday also tested positive the same day I did and so our home turned into a full quarantine facility.
Minding the Fear
Now, let me share my vulnerabilities as a psychologist and as a daughter in the past two weeks. While I managed to keep my calm and composure at all times and continue to manage the quarantine, the meals, procuring groceries, checking on Dad and SP to see their vitals were being maintained and to watch for any new symptoms, the frantic calls from my Tayajis and my sisters, cancelling and rescheduling my sessions, the worry would creep into me in the middle of the night, at least the first few nights, I would walk into his room around 2 AM to check if everything was OK, and I would get back to sleep after till I checked in again at 6:30 AM.
The “what ifs,” the worst case scenario images would come by and hook me at times, and all that I suggest to my clients, I started practicing on myself, and it worked. Visualization meditations, unhooking from thoughts, images, & feelings, centering myself when an emotional storm would hit, and finding my anchor and staying grounded became important techniques to keep me calm so that I was able to manage the distress that Dad & SP were going through.
The home quarantine finally kicked in under the guidance of an exemplary doctor who sent us our prescriptions and would be available for updates daily.
Our daily management of Covid included plenty of fluids, rest, a good night’s sleep, breathing exercises, walks inside the house to keep ourselves active and sane, and nutritious meals, even though I had no taste and smell, and I could have eaten cardboard too and not complained. Meditations and mindfulness techniques kept me calm and play a huge role in my resilience. Dad and I would spend time together like we used to every evening, reading books, and catching up with life in general. Calmness begets calmness, I noted, at least in our case.
My energy resources were completely devoted to managing things at home and work for the first week. I didn’t tell any of my friends or extended family about the illness because the calls and messages were tiring me out with the existing ones itself. I also wanted to take care of my Tayajis (my Dad’s older brothers) because I know how anxious they were too. So rationing of my energy was needed.
This much I know in hindsight and in conversation with my dear friend Dr. Gaurav Sachdeva, had I caved in and panicked and didn’t see the situation objectively along with the clinical presentation, test results, and Dad’s temperament as a patient, the management of our illnesses would have been very difficult.
I know each case of Covid is different. We were fortunate to get through with a mild infection and some people aren’t. I have grieved with many people who have lost loved ones to the illness, young and old, and every loss would break my heart because I have heard gut wrenching accounts of the sheer helplessness in being unable to save their loved ones, to not being able to be with them in their last days, and even at cremations. The grief of a loss due to Covid is unparalleled.
I have heard accounts of hospitalizations for mild infections which have led to significant psychological trauma because of the suffering you see around, and also the conditions of our hospitals, with the lack of infrastructure that Covid wards get, in terms of both equipment and manpower. The healthcare professionals are doing as much as they can, but we forget that they are also humans, who would be burning out, who would be worried for their own lives and their families, and yet they show up to work everyday.
We in our own misery would complain about the pathetic state of the hospitals that we call for the nurse five times and they show up once. But we rarely show empathy to the nurses and ward boys when we are anxious, so it doesn’t strike us that they could be overworked too.
Minding the Mind
When I started writing this piece, along with inputs from Gaurav, who is a physician and who himself had tested positive months ago, it was with the intention to talk about the psychological management of Covid, as a psychologist who herself got afflicted with it, so yes it’s a first-hand account. Gaurav provided the medical management inputs in addition.
The naysayers may say “but you had a mild bout, so you got lucky!” I agree. But the first few hours of the diagnosis that almost rings like a death knell in mostly everyone’s ears is what I want to talk about. However mild the symptoms may be, when you see “Covid POSITIVE” in capitals on your report, it does seem like the rug being pulled under from your feet. You get images of ventilators and ICU, and looming death because somehow those have been the images given to us over the past few months, not the high recovery rate. How you respond and not react to the news and the plan after that, is what matters.
Return to a state of psychological equilibrium if the diagnosis and/or symptoms have caused intense emotional distress: Shock, anger, anxiety, and mostly more anxiety. Usually a centering technique such as focusing your attention on your breath, and expanding your awareness into the surroundings by using your sense of sight, touch, smell, or hearing is enough to start unhooking you from the emotional storm. Or any other strategy that may work for you (a stress ball, praying/chanting, going for a walk, whatever it takes). It may take a few minutes, but calm down. You will most likely not be able to think through next steps if panic and anxiety are making your head fuzzy. Do not continue to keep the panic button pressed! Try not to at least!
Consult a doctor on the severity of the symptoms and the management and trust and follow their advice: There are tests that we were prescribed which helped us decide that we could manage our illnesses at home, despite Dad’s age and co-morbidities. We often take the decision making away from our elderly, and we also may give into their fears. Please consider their opinion, and hear them out. Discuss with family on what needs to be done, unless an urgent hospitalization in severe cases is mandated. Also, please keep an oximeter at home to measure oxygen saturation.
The body fights the infection and for that our immunity needs to be boosted. Despite the lack of appetite and potential loss of taste and smell, please eat well, and take plenty of fluids. Get enough rest, stay active within your home if your body allows it. I enjoyed mopping floors, cleaning dishes, and doing laundry and continue to do so since our home isolation persists. Yoga and pranayama were excellent ways to manage the ensuing anxiety as well.
Please continue to keep your immunity boosted throughout this period and for life, I would say. Exercise, proper nutrition, effective stress management, and a good night’s sleep would be my prescriptions.
I continued to work and engaged meaningfully with life. There would be bouts of fatigue and I reduced the number of sessions in the initial week but I am gradually back to full strength now. I would sit in our tiny garden and tend to Mom’s plants, or just mindfully walk in that space. It’s funny how when your freedom is taken away, you make do with every small nook and cranny to work in. It gives a new perspective to life.
Dos and Don’ts for friends and family wanting to support someone with Covid remotely:
— Please do not ask how they got the infection. There are enough things on their mind and their own worries and talking about how they acquired the virus won’t really help them deal with this better and frankly, nothing can be done about the causation, so why even ask.
— Instead do ask what you could do to support them and get them through this period. Please do not just say “I’m there in case you need any help,” but ask “What can I specifically do to help?” “Do you need food, medicines, anything else? I expressed a craving for chocolates and a friend did a safe, contactless delivery without my knowledge with an endearing “get well soon” note 😊 I asked for recommendations on what to watch on Netflix & Amazon Prime, what books to read, and also ordered a 1000 piece puzzle to start working on in between my sessions and taking care of home.
— I was overwhelmed by the sheer support from clients who I had to tell that I was Covid positive because I needed to cancel a few sessions initially to take care of the situation at home. They chanted for us, sent prayers, one family I work with sent me Giloy juice, and most told me to not worry about them till I recovered.
— Ask if they would like to talk on the phone or message. Tune in to how they are feeling and be there with them. Sometimes all I needed was someone just being there with me in silence, not to fix anything, not to solve anything, but just being there, often talking about the random and the mundane. Other people may need some more emotional support. Nothing helps more than knowing they are not alone in this.
— Understand if they do not respond to calls and messages. Trust me, there is enough going on in the life of a Covid positive person and their family. But gently check if they need anything or just an “I’m there for you” text.
— Let’s talk about the stigma for a bit that a Covid positive person may be subjected to. I didn’t hide the fact that I was infected. What is, is. Our home for some reason didn’t get the poster put outside that Covid people reside here, and neither was it barricaded. We have been very conscientious about staying inside the home and it helps that we aren’t social people so nobody has really come home since our diagnosis 😊 I think that has helped us immensely. But when I started talking to people to interview them about their own experiences, they felt the additional “shaming” because the Whatsapp groups of their sectors and towers would be buzzing with “House # has X number of covid patients,” or the calls that the residents then receive. Most said none of the calls were helpful, but just “Accha, aap ko Covid ho gaya! (Oh, you got Covid!”) I have heard harrowing accounts of agencies responsible for contacting Covid positive patients insist they get admitted even despite mild symptoms. In our case, no one enquired, and neither did we step out. We were strict about the quarantine by ourselves and were spared the calls and interrogations. Had we got the calls, I am sure we would have cooperated but the blatant labelling of Covid cases is a bit much. Truth be told, numbers in India are rising steadily, with highest numbers in a day being reported ever, and there is a slacking off in the three important directives: mask, physical distancing, and hygiene. Our efforts need to be in proactive prevention of the disease spread and not the unnecessary time and resources spent in labelling Covid positive peoples’ homes. I will repeat, destigmatize the illness.
— Learn more about it so that you understand the infectivity rate and not treat people like they are unsafe to be around when they have recovered completely.
— Please provide hope and healing and not give depressing prognosis, when the symptoms are mild and the person is recovering. I walked into Dad’s room when he was upset with a friend and telling him “Instead of lifting my spirits you are depressing me” because the friend was giving him all sorts of unnecessary advice and negative prognostic news which wasn’t needed. Trust me, it still isn’t needed.
— Yes, we are aware of post viral issues that may arise: Myalgia, weakness, fatigue, systemic complications, and anything else that comes up. The effects of the virus are far from being known completely, but that doesn’t mean that EVERYONE will have them. We are responsible, we are watchful, we know that, we don’t need to be constantly told to watch out 😊 Living in fear is not how I would like to live. Be prudent, be cautious, be mindful, but please live well, live mindfully.
6. I will speak from experience, and say that the management of the illness has a strong psychological component. Despite the mild symptoms, the mind is constantly looking out for deterioration (justifiably so), a worsening of symptoms, and it is anything but comfortable to be flooded with negative thoughts, images, feelings such as anxiety, and what is commonly called as Radio Doom & Gloom for the hopelessness one experiences. For those who have had moderate to severe symptoms, of course the impact is much more in case hospitalization is the recommended treatment. Please ensure that you are taking care of your emotional and mental health as well, and reach out for professional support in case you experience acute stress symptoms.
7. My mantra was “One step at a time, one day at a time.” It helped me immensely. There was a Plan A, Plan B, and Plan C in place for sure, so it was contingent on how things developed moment to moment. It helped to keep my mind reined in and not jump to what all could possibly go wrong. It helped my Dad immensely that I was calm. The support from family and a few friends who knew kept me going.
We need compassion, care, and support in these trying times, whether we are reeling from the financial, vocational, personal aftermath of the pandemic, or as individuals and families afflicted with the illness. We need to be more humane and less vilifying (the opposite of the evidence in mainstream news today). We need to take care of our loved ones, and ourselves, and yet lead an optimum quality of life which isn’t steeped in fear and paranoia but is mindful and prudent. We need to spread hope and love, and not depressing news that serves no purpose except to fear-monger. We need to be there for people in our best capacities, who are struggling with the illness and not shun them or stigmatize them.
What would you choose today?