My wife, Rosalyn, died in December 2020. We were married for 38 ½ years. I loved her. She was my best friend. And I miss her a lot.
Before I begin my story, I’d just like to say that my wife did not die of COVID. She had two COVID tests while she was at the hospital. One, when she was admitted to the Emergency Room (ER). The other when she was transferred from the Emergency Room to the Cardiac Cath Unit (CCU). Both tests were negative.
Upon hearing that she died, many people asked me, “Was she sick?” After all, to them it seemed very sudden. It was… but it wasn’t.
My wife was a very heavily health compromised individual. Roz was a person who had two heart attacks, cervical spondylosis, a defibrillator, and lost a toe to diabetes. In addition, she was hospitalized for two urinary tract infections (UTIs). She was also hospitalized for cellulitis in both legs.
But you couldn’t tell this from her personality. Roz loved life and everyone loved Roz.
Furthermore, her health conditions never stopped her. Roz had her walker and she had her transport chair. And Roz took them everywhere.
For about 21 years, Roz used her walker to roam up and down the halls of JFK Hospital. She made her way to Cardiac Rehab where she exercised three days a week.
She loved food shopping. And Roz used both the walker and transport chair as she made her way around Shop-Rite, FoodTown, and Glatt 27.
Roz enjoyed the malls. Many times I pushed her around in the transport chair while she looked at merchandise in the department stores and small retail places.
In addition, Roz and I went out to eat (before COVID) on a regular basis. She used the walker and transport chair to get in and out of the car. Then, we’d use them to get to our table in the restaurant. And eventually Roz would transfer out of the transport chair and into a restaurant chair.
But the best thing we did was vacations. We both loved baseball. And we both loved the New York Mets. We’ve been down to Mets Spring Training for the last ten out of twelve years.
And this was how we did it. Walker and transport chair with the Uber. Walker and transport chair through the airport and TSA. Walker and transport chair to get on the plane. Walker and transport chair to get off the plane. Walker and transport chair to the rental car place. Walker and transport chair to the hotel. Walker and transport chair to the stadium. Walker and transport chair to the restaurants after the game.
Have walker and transport chair— will travel.
But that wasn’t the only yearly baseball venture that we did. For the last three summers (not last summer because of the pandemic), we picked a city that the Mets were playing in, got tickets for 3-4 games, and flew out to see them play.
In the past three years we visited Atlanta, Chicago, and Pittsburgh. And we did the walker and transport chair thing with the Ubers, airports, hotels, stadiums, and restaurants.
As I said, Roz may have had underlying health conditions, but it never stopped her.
Deciding Upon JFK Hospital
So when did this start? Well to be honest— I don’t know. I can tell you when she started falling. Or when she was first admitted to JFK Hospital (JFK).
But to pinpoint when the infection first began taking its toll on her body? I really don’t know. She didn’t have a fever nor did she ever get a rash. And she never came down with symptoms that signify an illness (vomiting, nausea, blurred vision, diarrhea, headaches, etc.).
Could her falls be linked to a UTI? Perhaps. She wasn’t sleeping that well. Could her restlessness be a symptom of a UTI? Maybe. She regularly told me about her vivid dreams at night. Was that indicative of a UTI? Who knows?
Anyway after falling four times in a 48 hour period, we told the first aid squad to take her to JFK Hospital.
Now there is a major medical center about five minutes from where we live. There is another hospital about 10-15 minutes from our apartment. JFK Hospital is about 20-30 minutes from our co-op. So why did we go to JFK Hospital?
I worked at JFK Hospital for eleven years as the manager of the pharmacy department. So…
- I knew the doctors at JFK,
- I knew the nurses at JFK,
- I knew the staff at JFK,
- I knew the administrators at JFK,
- I knew the procedures at JFK,
- I knew the building at JFK and how to navigate around it.
I knew JFK Hospital. We’re going to JFK Hospital.
Diagnosing The Problem
Prior to the pandemic, if a patient came into the emergency room (ER), they sat in the waiting room. Usually there was a large group of people there waiting to be seen.
One by one these people were called up to the nurses’ station for patient information, insurance cards, and triage. Patients were then brought into an examining room where they were initially seen by a doctor or nurse. They provided blood for testing or had an x-ray or scan done. Finally, once the results were in, they were diagnosed by the doctor or nurse. And depending on the severity of the illness, were either admitted to the hospital or sent home.
This process could take 2-3 hours or more.
Because of the pandemic, my wife was brought directly into her own ER room. JFK Hospital’s emergency room is a series of individual rooms (much like a maternity unit or intensive care unit). There is no longer one large bed area in the ER, separated by curtains.
My wife was given a COVID test (standard procedure these days). It was negative. Next everything (the patient information person, the insurance person, and the triage nurse) came to her.
The goal of this first day was to answer two questions in order to best treat my wife:
- What microorganism was causing the UTI and
- What caused my wife to fall so much?
This is how they went about it:
- UTI: My wife was constantly supplying several tubes of blood for a variety of blood tests. She was also submitting urine samples for urinalysis. It was necessary to know what microorganism was causing the UTI, so that they could best treat my wife with the appropriate antibiotic. (I did contact a doctor friend of mine. He treated Roz last year when she was hospitalized with a UTI. He is a prominent physician who I’ve known for many years.)
- Falling: They took Roz for x-rays, scans, and ultra sounds of different parts of her body (head, brain, spinal column, legs, etc.). By performing these tests, it would determine whether this was a new problem or a previous damage to part of her body.
By 7:00 pm, we had not yet received results from all the tests. I decided to go home and get some rest before coming back the next day.
Worsening Over Time
At 2:00 am on Tuesday morning, I was awakened with a call from a doctor at JFK Hospital. . It seems that they were having trouble getting Roz’s blood pressure up. I drove to JFK around 3:00 am. Her blood pressure was 77 over something. My wife was given medication to increase the blood pressure. But even with medication, 77 was a very low heart rate.
By 9:00 am her blood pressure rose to around 99-102ish. That was still not that great, even with the medication, but at least it’s going up.
My goal was to go home, get some sleep, and come back later.
I arrived home and as soon as I walked through the door, the phone rang. It was a physician from the ER at JFK Hospital. He was detecting fluid in Roz’s lungs. He asked if I had a pulmonologist that I wanted to use. I said “Yes”. I recommended a pulmonologist that I’ve known for years. His group’s office was in the building right next to JFK Hospital. And if he personally was not available, then any member of his team would have been an outstanding specialist to best treat my wife.
I drove back to JFK Hospital and met the group’s pulmonology physician in the ER. She really wanted to move Roz to the units (ICU/CCU), but because of COVID, she didn’t have a bed. The physician also wanted to start Roz on BIPap machine. ( If you have trouble breathing, a BiPap machine can help push air into your lungs.) But since she couldn’t, the physician was going to order oxygen treatments for now. And she would work on getting my wife a bed in the units.
They started Roz on an oxygen treatment. Her oxygen level went up to 99. The treatment ended and her level dropped to 70. She got a second treatment. Roz’s oxygen level went back up to 99. When the treatment stopped, it again dropped back down to 70. They’d like it to stay above 85.
I have played the next part back and forth in my head several times, because I’m not exactly sure of what I heard. The hospital internist either said that “Roz’s kidneys were operating at 20%” or that she had “very low kidney function”. Either way —it was lousy.
I also found out that Roz’s BUN was crazy. This meant that her liver wasn’t functioning properly.
My doctor/friend was an infectious disease specialist. He prescribed Zosyn to treat my wife’s UTI (he used it last time as well). However, he unfortunately noticed that he was seeing signs of acidosis in the body. This meant that the pH of the body’s fluids were out of whack.
So Roz had a blood pressure that’s low, an oxygen level that kept dropping, a low kidney rate, complications with the liver, and acidosis in her body.
I have been in the hospital business for over 30 years. I am a registered pharmacist by trade. This did not have to be explained to me. I knew exactly what was happening. This was not a case of let's try another drug and maybe it will work. This was not that there was a glimmer of hope. This was a clear case of the Roz’s body shutting down due to an infection ravaging throughout her body.
If Roz was a healthy individual things might have been different. But Roz was a person who has had two heart attacks, cervical spondylosis, a defibrillator, diabetes, two UTIs, and cellulitis in both legs. As stated previously, she was a heavily health compromised individual.
They called two Rapid Responses. The entire medical team came down from ICU/CCU. The medical director and head physician of ICU/CCU (whom I have known for twenty years) came and examined my wife.
He examined Roz, then walked up to me and said, “I don’t like what I see.” I responded, “I don’t like what I see either.” He promised me that he and his team would do everything that they possibly could. However, he was not going pound on any chests.
Roz and I have talked about this throughout the years. We have both decided that it was not just life, but quality of life which was most important. Neither of us wanted to be kept alive, if we had to sacrifice quality. Thus, we both specified in our living wills that we were “do not resuscitate” (DNR). There was to be no heroics, no chest pounding, no CPR.
The medical director called my daughter at work and explained everything to her. He did not put the call on speaker, so I did not hear what she said. But I did hear his explanation. And I just stood there and nodded.
The next thing the medical director did was to turn the ER room that Roz was in into an ICU/CCU room. This meant that even though Roz was physically in a room in the ER, that the room was now an ICU/CCU room. Thus the entire team of medical people, the equipment, and all the necessary supplies were brought down from ICU/CCU floor and were at her disposal.
My daughter eventually arrived at the hospital. We stayed for a while and eventually left around 7:00 pm. We went home and made calls to people to brace themselves.
Making A Difficult Decision
The next day, my wife had been transferred to a CCU room. The only reason for this was for the benefit of the ICU/CCU team. That way the team did not have to run up and downstairs. They could stay upstairs (on the ICU/CCU unit) and take care of Roz. And they could take care of their other patients as well.
Roz was given another COVID test because she went from the ER to the units— she was still negative.
That morning, Roz’s condition was much worse. For the most part, the nurses were unable to get a blood pressure. In addition her oxygen level was still low and her kidney function was still poor.
Roz’s liver and BUN values were off the charts and acidosis was rampant through the body. My wife’s lungs and chest area were heavily congested. Her toes were blue, meaning the blood was not travelling to the toes. And there was a great deal of edema or fluid in her upper arms and shoulders.
The BIPap machine did not push sufficient oxygen into her lungs. She was on a ventilator turned up full blast.
As for medication, Roz was now on another drug, which was used in emergency settings to raise blood pressure. She was also on Diprivan (propofol)(the Michael Jackson drug) for sedation. And Fentanyl for the pain.
I knew what this was also. They were sedating her and keeping her comfortable, while providing medication for the pain.
While I was in the room with her, the nurse lowered the Fentanyl dose. Roz opened eyes (she couldn’t really talk because she had an intubation tube from the ventilator down her throat).
I said , “Do you love me Roz?” She nodded. “I love you, too.” Roz smiled. “And the kids love you also.” She nodded. “Oh and the grandkids love you too.” She sort of chuckled.
“And I taped The View for you.” Roz nodded again. “Oh and I’m working on a calendar for your birthday.” She smiled and nodded.
After thirty minutes, my wife, unfortunately, started thrashing and shaking. This was because the pain was returning since the nurse lowered the Fentanyl dose so that my wife and I could communicate.
But the pain was very intense at this point. So up went the Fentanyl dose, Roz went back into sedation mode, and there went my wife’s responses.
After lunch. I was in her room again. Roz was comfortable and heavily sedated. The nurse never again lowered her Fentanyl dose. Roz never again responded to anything I said.
Later that afternoon, Roz’s heart rate was 99. An IV bag containing one of her medications ran out. So the nurse disconnected the empty IV bag and reconnected a new medication IV bag. In the thirty seconds that it took to swap bags, Roz’s heart rate went from 99 to 30 something. Eventually after forty-five minutes, her heart rate crept its way back to 99.
I called my daughter to come to the hospital. She arrived soon. My son was already there.
It was obvious, at this point, that the machines and medications were running her body. So it was necessary to make a decision. Here were the choice:
- The staff could keep changing the IV bags as they ran out. For how long? Nobody knew. But eventually the body would crash, regardless of how much propofol and Fentanyl that Roz was receiving. And then what? It was already specified that my wife was a “do not resuscitate” (DNR). There was to be no heroics, no chest pounding, no CPR. This was a poor choice.
- The staff could keep changing the IV bags and hoped my wife got lucky. Then, Roz could be kept in a sedated yet unresponsive state for several days, weeks, or months. Perhaps Roz could even be transferred to a rehab facility or nursing home. Yes, she would be alive, but in a heavily sedated and unresponsive state. And if and when she did crash, then what would happen? From a quality of life perspective, this was a poor choice.
- The third choice was the best choice. It was also the toughest choice to make. Basically, my daughter, my son, and I did not want my wife to be in pain. We didn’t want her to suffer. We realized that it was these machines and medications that were keeping her alive.
We also knew that it was not possible to reverse any aspect of this. Roz would never recover. She would never get better. In fact, she would always become worse.
We knew that this was an extremely unwanted decision to make. But in the end. We knew that it was the right and only decision to make.
We needed to let Roz go. To die virtually pain-free, not suffering, and with dignity.
When my wife’s parents were in a similar situation, Roz was given a choice. She could be in their room while the staff disconnected the medications and machines. Or she could choose not to be in their room.
Roz elected not to be in the room. She chose this because she wanted to remember her parents in the “alive” state, not the “dead” state.
Roz and I have spoken about this many times. I felt the same way. I did not want to have my last image of Roz be in the “dead” state, as opposed to the “alive” state. So I elected not to be in her room.
My kids, on the other hand, wanted to be in the room. They did not want her to be alone. And that was fine. I had no problem with that. So I stepped out. The kids remained.
The staff disconnect the ventilator. They disconnected a few of the IV bag medications. But they continued with the propofol and Fentanyl— in order to ensure that she was well-sedated, felt no pain, and kept comfortable. Her body slowly began to shut down.
This process started at 6pm. Roz was gone by 6:30pm.
Loving My Wife and Letting Her Go
In reading this article, one might think that my daughter, son, and I made an instantaneous decision. After all, we had the three aforementioned options to choose from. Thus, based on my wife’s condition, it might be assumed that we quickly decided to end Roz’s life.
Nothing could be further from the truth.
First of all, I loved my wife!
Next, I knew where this was headed and I knew which decision needed to be made.. But I agonized over it for three hours. I talked to the doctors, nurses, hospital staff members, my family— anyone I could find.
I wanted reassurance that I was making the right choice. I knew I was. But I felt better when someone else told me that I was.
I didn’t want Roz to suffer. I knew she was in pain. But the propofol and Fentanyl kept her sedated and quite comfortable.
My wife wasn’t going to recover or even get any better. Roz died with dignity. She was surrounded by her family.
I loved Roz a lot. That’s why I had to let her go.
Daniel Shifrin, R.P., M.S. is a recently retired pharmacist who enjoys sharing his insights about hospital pharmacy. He is proud to own one of the largest collections of Pharmacy Stamp First Day Covers.