Will families of COVID-19 patients recover from trauma?

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“Her oxygen level was fluctuating — I thought it’s the end,” Subeena Showkat recalls the night when her 65-year-old mother Sakeena Hassan’s health began to decline as she fell to the pandemic.

Five days before, Sakeena had started coughing and passing loose stool till she lost her control and fell unconscious. It was past midnight and her husband, Ghulam Hassan, couldn’t do much but sit next to her and try to put her to sleep.

When he couldn’t handle the situation himself, Hassan called his married daughter.

“I lost my senses,” said Subeena.

She rushed to her parents’ home early in the morning, wearing two different broken footwear and night clothes. “I could see stool all over the bed. She was gasping.”

After testing positive for the COVID-19 virus, the family shifted Sakeena to Srinagar’s Chest Disease Hospital and the daughter went along. It’s been over a week now and Subeena, wearing the Personal Protective Equipment (PPE) suit and three masks, has been sitting next to her mother’s hospital bed.

“It [PPE suit] suffocates me but what choice do I have?” she said.

Subeena is among the thousands of attendants who are making a life-threatening choice of looking after their kith and kin, infected by a viral disease that has overwhelmed the healthcare facilities.

The attendants face high-risk of infection and also live through a traumatising experience of seeing their loved ones struggle for life. “Looking at them gasping for breath, unconscious… it leaves a void,” Subeena said.

Grief-stricken population

It was their third night at the hospital when tired Subeena dozed off for a moment only to wake up to an empty bed. “She was gone,” she said. Sakeena had removed her oxygen mask and left the room.

Subeena looked for her everywhere in the hospital and then she saw people gathered at stairs — gossiping about some naked woman. “I cursed myself for sleeping after seeing her [naked], I can’t understand why she did that,” she said. “I mean… why would she remove her clothes?”

After covering her body and putting her back to bed, doctors asked Subeena if her mother had a mental condition. “I felt angry and sad,” she said, adding that she had never seen Sakeena in that condition before. “She was fine. I think it was the shock of testing Corona positive.”

“I saw her twice in that condition but can’t afford to see her like that again,” she said. “It breaks my heart.”

A deadly second wave of the COVID-19 pandemic broke out in the Kashmir region in the last half of March and has since left a deathly trail as April registered 289 fatalities – highest single-month figure since the pandemic had begun last year.

The spread of the infection has also been fast as 45123 people in Jammu and Kashmir tested positive for COVID-19 in April. It has overburdened the healthcare facilities and the doctors in the region.

Mohsin Mushtaq, a doctor in one of Srinagar’s COVID-19 designated hospitals, said he could sense high-level of anxiety among the attendants.

“They are clearly under stress. They feel anxious,” he said.

Mushtaq and many other doctors like him sometimes want to help the attendants to handle the situation. “We see them dragging oxygen cylinders,” he said, adding that some patients don’t even have attendants.

“I see the trauma in this ward and they [attendants] see their relatives suffering. It’s disheartening,” said Mushtaq.

Many studies done by researchers across the globe since the pandemic suggest that “there is a possibility of a second pandemic: a grief pandemic”.

It’s not just the grief after the death but the anxiety of what-ifs. “Will I die?” Sakeena asks her daughter many times a day. Subeena falls silent every time.

The uncertainty of what is coming results in anticipatory grief. “I feel restless and scared,” said Subeena. The unsettled feeling of attendants not knowing if the patient will make it or not further fuels their anxiety.

Anticipatory grief

Last year, a study published by Science Direct, a website for scientific, technical, and medical research revealed that grief researchers have apprehensions that the COVID-19 pandemic “will precipitate increases in severe, persistent, and disabling grief, termed prolonged grief disorder or persistent complex bereavement disorder”.

The study further read that experiencing a recent loss “during the pandemic elicited more severe acute grief reactions than before the pandemic, suggesting that dealing with loss may be more difficult during this ongoing health crisis”.

Subeena is already distraught. “I think more than her illness, I am affected by her condition… the way she is, lying in grief.”

Sakeena, the ailing mother, wants to go home but her health has not improved so far. She often gasps for breath. Her attendant daughter – whose feet and hands are now swollen due to the sweating as she doesn’t remove her PPE suit – too craves for fresh air to breathe.

“I hardly sleep. I hardly eat. I only look after her,” she said, adding that it’s risky for her to remove her mask. “What if I contract the virus. I have three young children.”

Consultant Clinical Psychologist, Muzafar Khan, called the ongoing situation a “critical event”. “The population can develop the acute stress illness,” he said.

Khan believes that people can go through relapse if they have recovered from depression but the stress can increase if it is pre-existing. He said that the process of grieving has always been hard and “there is not much difference”.

Battling to be strong, next to her mother, Subeena has hardly spoken to her children ever since she left home for hospital. She said if her children talk to her, they will force their father to see her.

“It’s difficult,” she said. “I can’t risk infecting my children too.”

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