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Saturday, April 24, 2021

COVID Lockdown Sent A Doctor's Elderly Parents Spiraling. Here's What Helped : Shots - Health News - NPR

Kristen Uroda for NPR

As I walked away from my parents at the Toronto airport last June, I desperately wanted to turn back to them. I briefly stole a look and noticed my father jerking his fist into the air, as if he were cheering me on for a marathon. My mother stood motionless, crying until her glasses became foggy. She had promised not to cry, but her "baby" — as she increasingly called me — was flying away.

I was returning to Boston to start business school, after completing two years of surgical residency in the early months of the pandemic.

Meanwhile, my parents continued to hunker down in their two-bedroom apartment in Toronto. My mother was 71 and my father almost 80, both with several high-risk medical conditions. To avoid catching the coronavirus, they rarely went outside. When they had to, they worshipped the "6 feet of social distancing" guidance as a Platonic truth.

I'd never imagined them this isolated. In their younger days in Bangladesh, and even later in Canada, they had loved to party. The lockdown, which began with a declaration of emergency by the provincial government on March 17 of last year, changed everything.

No more gatherings. No traveling. After June, no more visits from their son. Some extended family members were nearby, but many of them, too, were higher-risk and in strict lockdown, limiting how much they could do.

The isolation mentally drained my parents. My father, once an active army colonel, would often lie in bed all day, even as I assured him in frequent calls and texts that there were safe ways to get outside occasionally if he wore a mask. At least, I said, he should keep up with friends by phone. He became noticeably quieter — a startling contrast to his formerly animated self.

My mother's motivation to engage with the world also started to wane. She would constantly perseverate on the pandemic — what she'd lost and what could've been — becoming a prisoner to her own thoughts.

"I'm not living life anymore, my son. I'm just killing time," she told me once, in a helpless tone.

"Keep going, Mom. Things will get better," I promised.

As the months wore on, unfortunately, things only got worse. The tragic news in July that a close family member — the wife of my mother's older brother — had passed away from COVID-19 pushed both my parents deeper into their pool of emotional quicksand. They were sinking fast.

I was getting worried, and called and texted them at least every other day.

While I did my best to stay on top of how they were doing, my parents did their best to foil that – they had a long habit of sheltering me from bad news. Just one example: I had downloaded the Uber app for my father on his phone several years earlier, and would get notifications every time they used the app. One day in November, I noticed an unexpected destination — their local hospital's emergency room.

I panicked. Had my father fallen and hit his head again? Was my mother having her second heart attack? Had either of them gotten COVID-19 and not told me?

I called them immediately. After pushing through my father's initial bluff, I learned that my mother was having a severe and excruciating flare-up of arthritis in her shoulder and spinal joints. She'd neglected her physical therapy routine for weeks, become bedridden, and now needed help getting the pain under control.

I found out about another emergency room visit a month later in much the same way.

The mental and physical aspects of their health were withering away in tandem. As a physician, I was gaining a deeper appreciation of the interplay between body and mind; as a son, however, I watched in horror.

I kept trying to intervene. I prescribed an exercise routine and urged them to take up some socially distanced outdoor activities with some of their friends. My advice occasionally helped, but only for a day or two, and never enough to slow their slide.

Eventually, in December 2020, a glimmer of hope surfaced with the distribution of the first doses of the COVID-19 vaccine; but for three excruciatingly long months, my parents weren't eligible. Many people over age 60 in the U.S. had gotten their second doses before my mother and father could get their first jab in Canada.

At last, they were OK'd to sign up in late March, and I spent six hours making calls to secure appointments for them. On March 26, they both got their first dose of the Pfizer vaccine. Though Canada was delaying second doses for up to four months, even a single dose felt like a victory for my family. The three of us celebrated — virtually, of course.

The very next day, my parents Facetimed me in an unusually cheery mood. They had just finished a walk — their first in several weeks.

"That was the most peaceful walk I've ever taken," my mother said, smiling.

Just looking at her on my tiny phone screen, I could tell that the cloud of paranoia was beginning to lift. They could finally enjoy something precious that the pandemic had stolen from them — a serene walk with each other.

My parents were suddenly eager to get on with their lives — ready to revamp their social life and catch up on lost time. But after nearly a year of self-deprivation, their approach was, understandably, a little overeager. The vaccine needed a couple of weeks to build its army of antibodies and confer maximum immunity, I explained. It was much too soon for them to fly to visit me in Boston or to attend large indoor Iftars, the meal eaten by Muslims to break their fast during Ramadan.

As a doctor, I knew that my parents also needed to regain physical strength and emotional resilience if they were to thrive in this still uncertain world. The coronavirus was still circulating at high levels in Toronto; the pandemic is still with us.

As I watched my mother and father last month swing from fear and isolation to post-vaccination over-confidence I was reminded of some of my experience working in the hospital. In medicine, we introduce nutrition carefully to a chronically malnourished patient. Ignoring this advice can lead to refeeding syndrome, a gorging that can overwhelm a still-frail metabolism and be fatal.

Over the next several weeks in our regular phone calls I worked with my mother and father, encouraging them to gradually introduce more activities into their daily routines. First were the walks. Then, the outdoor picnics. Then came indoor visits from one or two family members who had also been vaccinated. Masks all around — my parents have only had one vaccine dose so far.

At times, this delicate scheduling has felt more like art than science. The accumulation of COVID-19 scientific data has grown immeasurably, but it is still incomplete. The science always guides us, but our family, perhaps like yours, has filled in the grey areas with our own cautious, yet increasingly optimistic, approach.

It hasn't always been easy. My parents now have to make daily tradeoffs they've not made in over a year, prompting some decision-making anxiety. Should they go to their favorite, but more crowded, grocery store, they wondered? We talked it over and they decided it was worth it. Should they start taking public transport again to get around? They're holding off, but perhaps after their second dose. Navigating these "grey areas," it turns out, can be just as challenging as living through a full-blown lockdown.

But making these educated guesses about relative safety — reawakening to a new, uncertain world of learning and adapting — was their only way forward. And, more importantly, they are happy again.

"I promise to visit you both, after you get your second doses," I told them just a few days ago in a video call.

My mother suddenly perked up. My father blew me an air kiss – from his screen to mine.

This is one promise I'm determined to keep. A distant memory from the airport last year comes to mind. But something is different this time around. I'm walking toward my parents in my mind's eye. My mother is still crying, but this time, it's with tears of joy.

Dr. Shahdabul Faraz is a resident physician in general surgery and an MBA candidate at Harvard Business School.

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COVID Lockdown Sent A Doctor's Elderly Parents Spiraling. Here's What Helped : Shots - Health News - NPR
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