For the third time this week, I struggle with what to write as the official medical certifier of death on the State of Wisconsin Vital Records Office form in the CAUSE OF DEATH box.
It is ironic that during the past two weeks while attending on the inpatient wards at University Hospital in Madison, I was not called upon to perform this function, but in my outpatient role as a primary care physician, death-form completion recently has become far too commonplace.
Without a doubt, our lives have been upended by COVID-19, and we know that the most vulnerable among us — as for most other health conditions — are disproportionately affected. We all agonizingly watch our health care colleagues across the world struggle against the virus and bear witness to the economic hardships felt by so many in our community and elsewhere. Equally important is what former U.S. Surgeon General Dr. Vivek Murthy and internist Dr. Alice Chen have coined the “social recession” of COVID-19.
In a recent article for The Atlantic, Drs. Murthy and Chen predicted that “as people around the world retreat behind closed doors and sever connections with others, the damage COVID-19 causes could be no less profound and long-lasting.” Here is my firsthand attestation of that truth:
Anne*
Anne* was a self-proclaimed “super grandma” in her late 70s whom I have taken care of for more than 20 years. She had a never-ending supply of proud-grandma attire, and at our last visit — while wearing her eggshell blue sweatshirt that read, “My favorite people call me Grandma” — she again shared how her family propelled her forward, despite the metastatic cancer she had lived with for more than a decade.
In early March 2020, as nursing homes and assisted-living facilities wisely started closing their doors to visitors, Anne’s family could no longer make their nearly daily visits to her facility nor, since she was a wheelchair user, could they lovingly carry her up the steps to their homes for family dinners each Sunday.
At the end of March, Anne was admitted to the hospital with a new brain metastasis and, due to an appropriate COVID-19 mitigation policy, was unable to have her family at her bedside as they surely would have been. When I walked into her hospital room one afternoon, her face lit up as soon as she figured out who I was beneath my mask and shield. I had a hard time leaving because she had so many stories to share, seemingly starved for familiar human contact. About 10 days after her hospital discharge, I got my first death notification phone call of the week, which told me that Anne had died in her sleep at the nursing home where she was rehabbing after brain surgery.
Diane*
Diane* was in her 80s and coincidentally went to the same Chicago-area high school as I did. We figured this out because her husband, Joe* — before his death a few years ago — still wore his letterman jacket, which I immediately recognized. Over the years, especially after Joe developed cognitive impairment, he regularly regaled me with the story of his playoff-winning basketball shot in the same gym where I had a far-less-storied sports career many years later. Diane took meticulous care of Joe as his memory worsened, leaving him detailed instructions about food prep and his agenda for each day’s activities while she still worked part-time at a karate studio — where she had earned her black belt just a few years earlier.
Diane developed rapidly progressive Parkinson’s disease and related dementia, and for the past few years had resided in an assisted-living facility. Her daughter saw her nearly every day on her way home from teaching elementary school. After these visits stopped in March due to COVID-19, Diane became progressively withdrawn, despite the staff’s best attempts to help her use her phone to call her daughter.
A few days after her 80th birthday, Diane died with only her daughter at her side and other loved ones on Facetime. I got the call notifying me of her death two days after I heard about Anne.
Caroline*
Caroline* was in her mid-80s and gave me one of my most unusual and heartfelt gifts as a physician. She was a successful and prolific romance-novel writer, and she wrote a character in my honor as one of her novel’s heroines. When she presented me with “my” novel, I was a bit taken aback by the cover illustration of a buxom, long-haired brunette who, fortunately, bore little resemblance, and I have cherished this book ever since.
About a year ago, Caroline began to have uncharacteristic troubles remembering names and important details of her life, and she began seeing small gnomes on the patio outside her window. She was diagnosed with dementia and had a rapid decline, necessitating admission to a memory-care facility.
In March, her family tried regular window visits to make up for the in-person visits they were no longer able to make, but these had to be almost immediately suspended because Caroline became upset when she could not reconcile why she could see her family in the window yet their voices came only from the phone in her hand. This woman, who told me her family was “everything” to her, quickly became non-communicative once their visits stopped, and she died three days ago — my third such call of the week.
While it is not correct to list “COVID-19 infection” as the cause of death on their death certificates, I am convinced that it played a leading role in the demise of these three lovely, gregarious and strong matriarchs who were completely adored and fiercely loved. To battle my sadness about no longer having visits with each of them, I will choose to reflect and remember them as their engaging and vital selves wearing sweet sweatshirts, showing me a hard-earned black belt and proudly handing me the novel with the beautiful brunette on the cover.
*Names were changed to protect the identities of these amazing women to allow for private grieving by their families and friends. Permission to share these stories was obtained from the families.