Hi there:
I hope this message finds you in a good place, both mentally and physically.
As much as life has returned to normal in China, with mask-wearing and health codes a thing of the past, questions linger about what happened after the government abruptly dropped its containment protocols in early December. Statistics—to the extent they were available and reliable—paint an inadequate picture.
I found that this piece, first published in Chinese by The Livings on Feb. 20, fills the void nicely. In the aftermath of the rollback, author Yin Xi’s entire extended family was soon infected. Her paternal grandmother died. Her maternal grandmother, also in her 90s, clung on, but with most of the Yin clan either sick or recovering, caring for Grandma was a huge challenge.
In this deeply intimate and sensitive essay, Yin describes the extreme physical and emotional toll Grandma’s condition exacted on her caregivers and delves into the difficult debate of keeping elderly patients at home versus hospitalization. This is a story that I suspect was repeated in millions of families across the country.
This is a relatively long piece, so if you find your email truncated you can find the full story here.
Lastly, a few housekeeping matters. For subscribers old and new interested in a more thematic reading experience, I’ve put together a list of past stories organized by topic here.
Also, a friendly reminder that you can reach me by responding to this email or sending me a separate message at gushi@substack.com. Feel free to drop me a line to report errors or simply to share your thoughts.
Take care and see you soon.
—ML
COVID Unchecked: One Dead Grandparent, Another Critical, a Family Burnt-out and Divided
By Yin Xi
Edited by Tang Tang
1.
When the country's COVID containment measures were relaxed in early December, my oldest and youngest aunts were infected back-to-back. Soon, my maternal grandmother, who spent the most time with them in the same room, developed a persistent fever and cough.
Grandma was a tiny old woman who weighed a mere 35 kilograms or so. Since being diagnosed with Alzheimer's at age 73, it had been 20-plus years since she stopped recognizing immediate family members. She was also clueless about her own identity. Before she broke her left leg five years ago, she never hesitated to march a distance of a 2 or 3 kilometers. The world was her oyster. No one could stop her. But her leg never healed completed, and thus her range of movement became confined to her wheelchair and narrow bed. Her leg muscles deteriorated gradually until a coarse coat of skin that resembled linen hung limply on her bones. Whether she was prone or sitting, her left leg was reduced to contracted form. It was never able to extend again, let alone take another step.
Grandma gave birth to a son and three daughters. Uncle was the oldest, but he has had a hearing impairment since a young age that became a permanent disability. He communicated via sign language. That's why when it came to family matters, he was not much of a talker and more about execution. His wife and younger sisters made the big decisions, while he carried out his duties earnestly. Grandma had always been meticulously cared for by Uncle, while Mom and her sisters would stay over for fixed periods at Uncle's place periodically so that Uncle and his wife could take a break for a few days. That division of labor was interrupted when Uncle was diagnosed with mid-/late-stage stomach cancer in early 2022. Uncle's family of three was completely consumed by surgical procedures and chemotherapy. After Youngest Aunt conferred with her two older sisters, Grandma was relocated to the suburbs. All three sisters lived in the suburbs, which made it easier to take care of Grandma.
All three sisters are retired. Oldest Aunt has a granddaughter she picks up from school rain or shine every day, despite the 10-plus kilometer bus ride. My mom was diagnosed with breast cancer a few years ago. Surgery and chemo had made her extremely weak. She struggled to exert her right arm, where her lymph nodes had been removed. Lifting a wok while stir frying a plate of veggies zapped all her energy. My dad had to prepare her three daily meals. Youngest Aunt doesn't have grandchildren to care for. Her daughter is single and has a steady government job in the city. Youngest Aunt's husband had also just retired. The couple were in good health and had plenty of time. Considering all factors, Youngest Aunt was the one who had the time and energy to be a caregiver.
Before her older sisters could ask, Youngest Aunt volunteered for duty. She cleared out her study and bought an advanced hospital bed that could recline and turn patients sideways. She also stocked up on diapers, a wheelchair, fresh bed sheets and a change of clothing. Before Grandma made the move, Youngest Aunt had attended to every single detail. Taking care of the elderly may pose a burden or baggage for others, but Youngest Aunt anticipated Grandma's arrival with joy.
**
Before Grandma fell sick, Youngest Aunt's father-in-law had already been infected and turned critical. Youngest Aunt's husband, who himself was infected, had no choice but to move in with his father, leaving Youngest Aunt to care for Grandma single-handedly. Oldest Aunt would stop by to help out on occasion. I also lent a hand on my mother's behalf when work wasn't busy.
During one stint, I stayed at Youngest Aunt's apartment for a few days. After feeding Grandma dinner and fruit, we'd sit in front of the TV together to tune into music channels. Grandma loved music. One night, I asked Youngest Aunt whether she felt stuck having to stay at home with Grandma every day instead of going to drawing and guzheng lessons as she did in the past. She answered no.
She proceeded to relay a conversation she had with Grandpa before he passed away.
I was in university at the time. Grandpa was hospitalized in the ICU in critical condition. It was Youngest Aunt's turn to keep an eye on Grandpa that day. Grandpa kept staring at her hard. Youngest Aunt could tell that something was wrong, so she crept up to Grandpa and asked: "Dad, is there something you want to say?" But Grandpa was intubated at the time and couldn't say a word. All he could do was keep staring. Then it suddenly dawned on Youngest Aunt what was on Grandpa's mind. She crouched next to Grandpa's ear and whispered: "Dad, did you want to ask me to take care of the family?" Lo and behold, Grandpa nodded. Youngest Aunt froze briefly, then smiled. She continued: "Dad, rest easy. I know what you're worried about. I promise you that I'll take care of our family properly. I'll take good care of my mom. I'll take good care of my brother."
Grandpa passed away in the wee hours after Youngest Aunt left that day. Youngest Aunt said she never forgot the promise she made to Grandpa. She just never had the chance to move Grandma to her home. When Uncle fell ill, she realized it was time for her to keep her promise. For the past six months or so, Youngest Aunt dedicated herself to Grandma wholeheartedly. With Grandma visibly gaining weight, Uncle could finally focus on his own treatment.
Evrn though she was trapped at home every day living an isolated existence, Youngest Aunt said she was delighted. She could finally carry the family's heavy load by taking care of Grandma and Uncle properly. She still hadn't had enough of it.
**
During her first week of infection, Grandma's temperature constantly fluctuated between 36 and 38 Celsius. Whenever she was on medication, her temperature dropped. Whenever she stopped taking medication, her temperature spiked. Our family's mood oscillated along with her temperature. Our family WeChat group became her patient chart. Youngest Aunt kept a detailed caretaker log. "Body temp 37.8 this morning." "Fed her two eggs and a bowl of milk oatmeal at 10 a.m." "Body temp 38.3 at 2 p.m." "Had trouble swallowing anti-inflammatory pill, so switched to powder mix."
On the 10th day of her fever, Grandma lost her appetite completely. All she ingested the entire day was two spoonfuls of water. Youngest Aunt called my mom frantically, asking her to rush over and help brainstorm solutions. But at the time my mom was busy burying my paternal grandmother and couldn't get away. Granny passed away on the evening of Dec. 25. COVID prompted a persistent high fever and she choked on her own phlegm. She died instantly.
In our family conference call, Youngest Aunt and Oldest Aunt, who had just recovered from COVID, were on one end and my mom was on the other. As the middle sister, my mom naturally had to first hear out Oldest Aunt and Youngest Aunt, who had been taking care of Grandma day and night. Oldest Aunt said decisively: "I have a single point to make. I've discussed the matter with our brother's wife. No matter what, we are treating Mom at home, not the hospital.
Before my mother could respond, Youngest Aunt fired away: "What if we can't cure her at home?" Oldest Aunt didn't answer directly, instead asking my mom for her take. My mom said she opposed hospitalizing Grandma. The old lady was already 95 and couldn't handle it physically, she said.
Oldest Aunt followed up by saying: "The word online is that even getting a CT at a hospital can take several hours. Mom is so old. A single wait can take up a whole day. Odds are she'll die of exhaustion before having her COVID treated."
My mom also cited the example of my paternal grandmother. She never set foot in a hospital before she died because my dad gave strict orders to my aunt, who was taking care of her. Granny was not to be hospitalized under any circumstances. "If she dies, she's going to die at home," Dad said. My aunt always followed her big brother's lead. In the end, she cradled Granny's head in her lap and watched her take her final breath.
My aunt is not a stubborn person. Unable to withstand the case made by her two older sisters, she agreed to keep Grandma at home. The three sisters appeared to have reached a consensus of sorts.
2.
Two days later, my family set off for the mountains in the early morning to bury my paternal grandmother in my hometown's ancestral plot. Just before noon, only moments after the dirt had been paved, I got a voice message from Youngest Aunt. It was sent to me not individually, not in our family WeChat group. Youngest Aunt said Grandma hadn't eaten in three straight days and wasn't even drinking water. The little fat clinging to her stomach had vanished. When you lifted her top, all you could see was shriveled skin. "What should we do?" Youngest Aunt asked.
Youngest Aunt had been Grandma's primary caretaker in the past six months. I'd drop by every few days to visit Grandma, dessert in hand, chat with Youngest Aunt and listen to Grandma mutter gibberish. Perhaps over time that leveled Youngest Aunt's trust level in me vis a vis her two sisters. That's why when she landed in a desperate situation, she placed her hope in me.
After listening to Youngest Aunt's voicemail, I could more or less guess what was on her mind. She had never banished the idea of sending Grandma to the hospital. For her to contact me individually, not to ask for help in feeding Grandma medication or getting her to eat—it was clear she was seeking assurance or reinforcement for her hospitalization move.
I knew what the other sisters had decided and understood their reasoning. Be it Granny or Grandma, they were both in their 90s and had Alzheimer's. Granny often called her own son "Dad" while Grandma called Youngest Aunt "Mom." Neither could enunciate properly, only able to manage utterances that resembled a baby's squeals. They had no quality of life to speak of—and yet they had to bog down a healthy human being who was on constant standby, unable to step away for the briefest moment. The slightest slip and you would find my grandmothers drinking from the toilet bowl or setting fire to their comforters with a lighter. These were regular occurrences.
As time went by, any amount of familial affection had long been drained to drips. Exhaustion and a profound burden were the stark reality. Plus these were extraordinary times, with the children themselves coming down with COVID one after another. The kids barely able to care for themselves, to hospitalize the elders at this juncture not only posed a physical challenge to the elders, it was also a cruel test of endurance for the offspring who accompanied the elders. Treatment at home seemed the better option that reduced overall attrition as a family. As for whether or not the elders would survive, it was up to fate to decide.
That's why from a family perspective, not hospitalizing the elders was the sensible choice after weighing pros and cons. Most people could understand what a tough call it was and the factors involved. That being the logic, casual talk was easy, but when it came to execution, only then could one appreciate the meaning of "easier said than done."
The fact is I was also torn on the matter of hospitalizing Grandma or not those few days. I called Youngest Aunt back. When the call went through, Youngest Aunt recapped Grandma's condition again, highlighting the urgency of the situation. When I asked what her plan of action was, Youngest Aunt went silent for a minute or so.
My sense was that Youngest Aunt was deeply conflicted. On one hand was the consensus she had reached with her older sisters and on the other, her true desire. It was impossible for her to take a side with a complete peace of mind because whatever she decided, she would feel bad and put herself in awkward position. Plus at that point in time she and her husband were each taking care of a respective parent, separated by some 20 or 30 kilometers. She was missing her strongest source of support.
When she finally spoke, Youngest Aunt asked me: "Can we send her to the hospital?"
I felt thankful that Youngest Aunt and I were on the same page after she agonized over her decision. The fact is I felt just as trapped as she did, especially having experienced Granny's sudden death. The nightmarish prospect of losing two family members consecutively terrified me. But as a grandkid, I had no choice but to defer to my elders, especially on a sensitive matter like this. If I overstepped bounds and overrode my mother's decision, not only would it embarrass her—it would make her look cold and unfeeling. For Youngest Aunt to take a stand now and draw me into her fold—that gave me an excuse and cover.
But I still didn't feel at peace. This plan put Grandma's life and the lives of other family members at risk, after all.
I proceeded to share my worries over the phone, also listing to Youngest Aunt the risks of hospitalization over the phone. Maybe Grandma's condition wouldn't improve after hospitalization. Maybe her condition would turn critical over time. Maybe Grandma's would recover and then get infected for a second time. In the end, I said: "If we can handle the most horrific outcome, if we prepare for the worst, we should give it a try."
Youngest Aunt went silent again. She seemed to be pondering my words. Now that I was involved, I also envisioned all sorts of scenarios in my head. Eventually, Youngest Aunt said: "I really couldn't live with myself if I did nothing and watched Grandma take her last breath." Sobs followed, their sound striking a higher pitch than Youngest Aunt's voice. But I could tell she was restraining herself. "How about we give it a try, OK? Even if Grandma doesn't survive, at least we tried, no?"
At that moment it dawned on me I had no reason to be timid anymore. I also knew that the debate over whether or not to hospitalize Grandma would become my family's biggest source of disagreement and conflict that winter.
3.
After hanging up with Youngest Aunt, I tracked down Mom and Dad and told them about the suggestion to hospitalize Grandma. As expected, they responded with skepticism. My mom even accused Youngest Aunt of not only betraying an agreement among sisters, but also breaching family code. "She's putting you, a junior, in an awkward position," Mom said. Dad simply retorted: "I'm not in favor of hospitalization." Mom followed up by saying: "We agreed at the outset not to hospitalize Grandma. Don't listen to your Youngest Aunt and lose your senses too."
I went silent.
As I drove my parents home from our ancestral burial plot, I didn't defend Youngest Aunt, nor did I explain myself. I just told my parents that if Grandma and Granny passed away consecutively, organizing funerals for two elders in a row would take an extreme physical toll on both of them. The reason I backed Youngest Aunt's suggestion to hospitalize Grandma was to buy my parents a bit of down time, be it only a night or two. "I don't want any more members of this family falling sick," I said.
While I failed to secure my parents' support on my end, Youngest Aunt also didn't find a sympathetic ear in Oldest Aunt. The two sisters were camped out at Youngest Aunt's place together to take care of Grandma for a few days. After hanging up with me, Youngest Aunt relayed our decision to Oldest Aunt, which prompted the later to raise her voice and declare abruptly: "Go. Let's go then. The hospital it is."
Youngest Aunt couldn't tell that Oldest Aunt was being sarcastic and proceeded to pack, tracking down a change of clothes, diapers, Grandma's drinking cup and urinal pad, as well as other personal items. Oldest Aunt looked on without emotion.
When our car reached Youngest Aunt's apartment building, Youngest Aunt asked Oldest Aunt to carry Grandma from her bed to her wheelchair. Oldest Aunt retorted: "I'm not going to the hospital." Youngest Aunt could only swallow her anger as she herself embraced Grandma with both hands and lifted her onto her wheelchair.
As soon as Grandma was moved to my car, Oldest Aunt turned around and bolted. When I asked for her, she blurted without looking back: "I'm heading home." Youngest Aunt asked my mom to join her in the car, but Mom and Dad stood silently next to each other.
No one argued openly at the time, but the tense dynamics made clear that the battle lines had been drawn. Youngest Aunt and I were in one camp while the others formed another.
I tried to pre-empt the stalemate by telling Youngest Aunt that my parents were exhausted from attending to Granny's funeral for several days straight and that I ordered them to get some rest at home. That way the blame fell on me. The naive person that she is, Youngest Aunt bought my explanation. After bidding farewell to her sister and brother-in-law, she ducked into my car immediately. Cradling Grandma's head in one hand and carrying her injured leg in another, Youngest Aunt muttered: "Mom, just lean on me. That's right. I got you."
I could see in my rear view mirror that Grandma appeared to be losing consciousness. She probably couldn't hear Youngest Aunt. Still, Youngest Aunt kept repeating: "Mom, we're headed to the hospital now. Bear with me. We'll be there soon. Once we get there, you'll recover."
Youngest Aunt hadn't called Grandma "Mom" in ages. Instead, she referred to her mother as "Old Chen," as if addressing a longtime friend. Having had Alzheimer's for some time, Grandma couldn't recognize Youngest Aunt and didn't care what she called her. That's why the moniker "Old Chen" gave Youngest Aunt more comfort than "Mom" on a daily basis. The name "Old Chen" didn't elicit a response, but Youngest Aunt didn't mind. Meanwhile, the lack of response to "Mom," not even a blank stare, had devastated her over and over again.
It was an hourlong drive from Youngest Aunt's apartment to the hospital. Youngest Aunt spent nearly half the time venting and crying. She resembled a wrongfully accused child who finally saw her parent, channeling her emotions furiously.
Youngest Aunt said it was she who took care of Grandma every day. It was she who cooked for Grandma, changed her diapers and wiped her body clean. "And yet why am I still tortured by my conscience after all that hard and unpleasant labor?" she wondered. As Grandma's primary caretaker, Youngest Aunt said she witnessed a relatively healthy person fall sick, turn weak and then finally deteriorate to a shallow breath and hanging onto life by a thread. "I'd be affected and hurt if it were a stranger, let alone my own mother. I really can't bear watching her struggle on her own," she said.
I didn't let out so much as a grunt, simply listening on quietly. I suspected these were thoughts she had bottled up for a long time but couldn't find anyone to unload to.
4.
Youngest Aunt and I spent a painful day and night with Grandma in the hospital ER.
The ER was absolutely packed, both indoors and near the entrance. Getting a number, seeing the doctor, lab tests, getting an IV drip—every small step took at least hours to complete.
Most of the ubiquitous patients were pale, feeble men and women like Grandma. They sat in wheelchairs, their bodies covered with floral-patterned comforters, usually accompanied by two or three family members. The children were mostly middle-aged men and women who looked jaundiced. Even if they weren't infected or feverish, spending hours in a crowded, noisy and poorly ventilated environment like this was bound to knock the wind out of a healthy person.
After a 3-hour wait, we finally received Grandma's test results. After reviewing the paperwork, the doctor asked in an accusatory tone: "The old lady is in such a critical condition. What took you so long?"
Youngest Aunt and I exchanged embarrassed glances. I asked the doctor how critical Grandma's condition was. "She would have been brain dead if she were brought in any later," he said. I looked at Youngest Aunt again, unsure whether we should celebrate our good fortune or self-blame.
We spent the night in the ER. A tube was fed into Grandma's stomach through her nose while an IV was attached to her wrist. Every 15 minutes, Youngest Aunt and I took turns squeezing 20-milliliter doses of water from a syringe into the stomach tube, to alleviate Grandma's severe dehydration. Youngest Aunt retrieved a pen and hardback notebook from her handbag. She recorded every dose of water administered, every single swap of the IV drip, every inhalation from the oxygen tank and every vaporization treatment. Doctor's orders were to feed Grandma a total of 2,000 milliliters of water that night—the equivalent of 100 pushes of the syringe. Youngest Aunt drew up a table with 2,000 milliliters written prominently on the top, along with side columns listing the time of every scheduled water delivery. She marked every syringe push with a large tick, as if conducting a serious scientific experiment or overseeing a solemn ritual.
The next morning, Grandma was no longer critical as her condition improved significantly. But Youngest Aunt, who had stayed up all night, started coughing violently and I had become drowsy. Mom and Oldest Aunt had called once or twice after we arrived at the hospital for a status update but made mention of little else, let alone relief duty.
After a mere day and night, Youngest Aunt and I were totally drained—precisely the scenario my parents and Oldest Aunt had feared. It was ironic indeed. Still, I didn't think we made the wrong call. It's just that we couldn't last long without backup and reinforcement.
After a follow-up consult, I asked the doctor if we could finish Grandma's remaining IV drips at home. With the hospital stretched thin and beds in high demand—plus elderly patients like Grandma needed the personal attention of nursing aides—the doctor was delighted to release Grandma and reduce the hospital's overall workload.
After obtaining Grandma's prescription, I drove Youngest Aunt and Grandma home. Youngest Aunt fought the intense urge to fall asleep during the ride home, but still managed to make conversation with me from time to time. She was worried that I might doze off on the wheel as well.
After setting up Grandma in her small bed again, Youngest Aunt and I each collapsed onto an armchair, as if a huge weight had been lifted from us. Only our nerves throbbed violently and headaches surged periodically. These were signs of an excited state during sleep deprivation.
After returning from the hospital, I developed a fever soon as well and became too sick to leave the house. Mom and Dad also tested positive after returning from Granny's funeral. Oldest Aunt never returned to Youngest Aunt's place to help out again, leaving Youngest Aunt all alone to take care of Grandma in her largely empty three-bedroom flat.
And so with neither the people sticking by Grandma's side nor those who left broaching the source of dispute, the two rival camps in my family pretended that life carried on as usual. But people's emotions can't be suppressed. Two weeks after returning from the hospital, Youngest Aunt had a mental breakdown one evening.
5.
At 9:15 p.m. that night, I received three consecutive voice messages from Youngest Aunt, each lasting no more than 10 seconds. Sounding weak and short of breath, she got straight to the point: "I have a really bad headache. Can you come over to help take care of Grandma?"
I relayed the message to my mother as I changed. Mom got up from bed immediately. "Why is she always bypassing her older sister and reaching out to you, a junior?" she wondered out loud, even the video she was playing on her phone no match for the volume of her voice.
I didn't respond, simply asking her to call Youngest Aunt for a status update. When the call went through, all we could hear was the sound of Youngest Aunt crying hysterically. The crying sounded exceptionally fierce and scary given the time of day. Mom's facial expression turned tense immediately. She kept repeating Youngest Aunt's name and asking what was wrong. But all Youngest Aunt did was cry. She cried continuously, to the extent where she couldn't squeeze in a single sentence.
I ran out of patience too, proceeding to yell at Youngest Aunt, ordering her to calm down. I was completely out of line, but this was hardly the time to observe decorum. Youngest Aunt finally managed to grit her teeth and grunt: "Headache. So painful." Then she started crying hysterically again.
Sensing the severity of the situation, Mom, Dad and I way drove to Youngest Aunt's place frantically. En route, we wondered if Youngest Aunt's hysteria had something to do with the fact that Grandma was near death. But when we arrived, Grandma's eyes were wide open. She even arched her eyebrows at me a few times and made a few monosyllabic sounds. She seemed in good spirits. Meanwhile, Youngest Aunt was reduced to a shriveled state on her own bed in her bedroom, rubbing her head against the bedsheets. The lights were off. She resembled a small animal licking her own wounds in the dark.
I rushed to Youngest Aunt's side and cradled her head, hoping to gauge her mental state. The first thing I felt was the dampness of the tears on her cheeks. Youngest Aunt's eye were shut tight. Wrinkles radiated outward, making her seem much older. The first thing she said to me in spite of the pain was: "It's 10, isn't it? It's time to feed your grandmother water."
I remembered that Youngest Aunt kept a thermometer on her nightstand. I grabbed it and passed it to Youngest Aunt, then got up and made my way to Grandma's bedroom, where I proficiently pushed a syringe full of water down Grandma's stomach tube and logged the event on Youngest Aunt's notebook. I then plucked a Q-tip from the small container by Grandma's bed, dabbled it in water and rubbed it against Grandma's lips and tongue. I had long committed to heart the layout of Grandma's bedroom and the steps involved in her care. At that moment Youngest Aunt and I had an unspoken bond. By contrast, Mom and Dad, who stood to one side, came off as guests, while Youngest Aunt and I were the hosts. The unspeakable divide between the two camps once again came to the fore.
**
Youngest Aunt had never suffered from headaches before, so I took her blood pressure. It was twice her usual level. When she saw the measurement, Youngest Aunt said: "No wonder I had a splitting headache."
"What did you do to make your blood pressure spike?" I asked.
Youngest Aunt was rubbing her temples. After a few rubs, she finally said it was because she was worried that Grandma might not make it through the night. Grandma's eyes were open half of the time in the few days prior, but that night she still hadn't woken up by the time Youngest Aunt sent me those voice messages. Youngest Aunt was terrified. She wanted to get a second opinion, but she gave up the idea when she remembered how her two older sisters felt about Grandma's hospitalization. She also didn't feel comfortable calling her own husband. Uncle's own father also had a lingering high fever at the time. As son, Uncle had his hands full. At wit's end, Youngest Aunt eventually succumbed to an endless cycle of fear and worry, which sent her nerves into overdrive and caused the splitting headache.
"This is your own doing," Mom blurted as she sat near Youngest Aunt's bedboard. If Grandma hadn't been hospitalized, she said, then she wouldn't have a tube stuck in her nose and Oldest Aunt would also be around to help out. Youngest Aunt wouldn't be left to fend for herself. Then Mom finally unleashed the question she had been dying to ask: "Why did you change your mind after the three of us agreed not to hospitalize Mom?"
Youngest Aunt's eyes were glued shut. Her fingers were dug into her scalp as she scratched furiously.
Dad also interjected: "The old lady is at such advanced age. She could go at any given moment. Shouldn't you be mentally prepared? How did you end up winding yourself up like this?"
Youngest Aunt remained silent, eyes shut.
I could see where Mom and Dad were coming from. From their perspective, these weren't harsh words, but rather the judgment of a calm and rational adult. In their eyes, Youngest Aunt was a bit naive and impulsive, easily swayed by her emotions. That's why my parents spoke with the tone of stern elders.
"Fine! Fine! Fine!" Youngest Aunt screamed as she suddenly dropped her hands, leaving her hair in an utterly disheveled state. "It's all my fault. I'm the one who insisted on hospitalizing her. I insisted on saving her life. I sent myself into tailspin. It's all on me!"
Clearly, this was a temper tantrum.
"But have you seen Grandma in pain? Have you seen her hands grasping toward the ceiling in the middle of the night? I have! Plus I know she wants to live. I could see it in her eyes when she stared at me during her fever. For real. I have eyes on her every single day. From her diet to discharge of bodily fluids, I know her every detail. That stare, that desire to live—it's something else. Really, I can tell."
The more she spoke, the more emotional Youngest Aunt became. Tears covered her face again. A headache struck again, forcing her to pause, then sob. I rubbed her back and reminded her to take deep breaths. Finally, the headache subsided. Youngest Aunt was so tired she was sprawled on her bed, her eyes vacant. Still, she managed to say to my parents: "If you had seen Mom in that state, it would have been impossible for you to be completely rational."
6.
After Youngest Aunt had her meltdown, I decided to spend an hour or two every day at her place, to keep her and Grandma company.
Mom's stance softened significantly. Sometimes she joined me on my visits and even chatted with Youngest Aunt. Still, to preserve face, she felt compelled to mention Youngest Aunt's "betrayal" from time to time. The routine was not directed at others. Instead, it appeared to serve as a reminder to herself of her original position.
And thus a week went by peacefully. Yet as the rest of the family recovered from COVID and clung to the prospect of Grandma showing a major improvement as well, another mishap struck.
On the day of Grandma's deterioration, I had just visited in the morning and administered a vaporization treatment. Everything seemed par for the course. Grandma and I even "conversed" as she made a few monosyllabic noises. But Youngest Aunt called abruptly in the afternoon, her voice trembling.
As my parents and I rushed over to Youngest Aunt's apartment complex, Youngest Aunt called again via videoconference. The video footage showed Grandma's body and hands shaking non-stop from spams. We could tell from Youngest Aunt's voice that she was terrified. "I should call (emergency hotline) 120. I should call 120. Should I call 120?" she mumbled.
Mom didn't respond. I looked over. I could tell she was torn yet again over the question of whether or not to hospitalize Grandma. So I decided to speak up again. "Mom, let's call an ambulance," I said after a gentle shove.
I could detect the sense of panic in my mother's eyes. When push came to shove, she couldn't stay completely rational either.
Mom nodded to me and to Youngest Aunt over the phone, finally signing off on hospitalization. The ambulance transported Grandma to a trauma room directly. By then she was suffering from a fever of 39 Celsius and had lost consciousness. The doctor said she was critical. When Oldest Aunt arrived at the hospital, Grandma's condition hadn't improved—and Youngest Aunt had fallen ill as well. Her headaches raged again. In her words, it felt like "a hand rummaging around in her head." When she was in too much pain, she lied flat on the bench outside the trauma room and closed her eyes.
This was the first time Oldest Aunt and Youngest Aunt had seen each other since their spat. Noticing that Youngest Aunt was in discomfort, Oldest Aunt didn't bother to say hi or offer a word of consolation, simply looking on from a distance like a stranger. Eventually Youngest Aunt was in so much pain she had herself looked at as well. After she received her test results, the doctor said Youngest Aunt needed a few IV drips to lower her blood pressure.
That night, Grandma received drugs intravenously while Youngest Aunt also did the same in a treatment room upstairs. Neither mother or daughter could pay each other much heed. During the drive to the hospital, my mother twisted her back. In the ER, she could neither sit or stand comfortably and turned ghastly pale. When I told her to head home, Oldest Aunt also complained of back pain and tagged along with my parents.
In the end, only Youngest Aunt, Grandma and I remained in the hospital. It was deja vu.
**
After completing her IV drips in the wee hours, Youngest Aunt felt a bit better. Seizing the window when the doctor and nurses treating Grandma were away, she snuck into the trauma room to check on Grandma. At that point Grandma had already taken her medication and her fever had subsided. She was still unconscious though, her eyes shut.
Using her hand that had just been relieved of an IV port, Youngest Aunt felt Grandma's forehead, then leaned over and pressed her own forehead against it. This was their daily ritual. Every morning, Youngest Aunt dropped by Grandma's bed to say hi and they touched foreheads. It was their way of marking a new day.
But this time, after touching foreheads, Youngest Aunt whispered: "Sorry, Mom."
I found out later that this was the day Youngest Aunt changed her mind. She finally realized that although her sisters' decision may not have been the right one, it was the best thought out. Only when her own health started to suffer did she begin to confront the cruel, practical dilemma she had to resolve. It was a lose-lose but unavoidable call.
**
Because of the severity of the COVID rebound, family members were banned from visiting and staying with patients. During this hospitalization, Grandma was under the care of nurses and nursing aides. Our family finally earned a long-overdue break.
At one point, doctors tried to talk us into taking Grandma home. Because of a bed shortage, Grandma couldn't be moved to the general ward. Meanwhile, Grandma's condition technically disqualified her from an ER spot. She became a refugee in the ER who couldn't be moved or discharged. Doctors could only "suggest" that we take her home of our own volition.
But this time around, both Youngest Aunt and I decided to be "selfish." Neither of us agreed to taking Grandma home. Grandma was taken care of at the hospital. Who would take care of her if she went home? If you went down the roster top to bottom and back up, everyone was either sick or still recovering from COVID. There was no one who could take care of Grandma round-the-clock.
Youngest Aunt's headaches never went away, prompting her to seek treatment at several other hospitals. She didn't want to impose on her husband or let her daughter know. At that point my cousin hadn't come down with COVID yet, plus she had a busy job and lived far away. During that period, not a single person blamed my cousin for not helping out. There was a tacit understanding that she was still a child and didn't need to get involved in the affairs of the adults in the family.
So we could only choose to play dumb with the hospital. Even though we got the cold shoulder every time we visited the hospital to ask the doctors for an update, we responded with smiles and didn't lose our temper. After all, Grandma was in safer hands in their care than in ours.
7.
I was under the impression that Youngest Aunt had thoroughly weighed the pros and cons of hospitalization. That turned out to be an illusion.
Three days before the first day of the Year of the Rabbit, I stopped by Youngest Aunt's place to pick up a few things. I hadn't been there since Grandma's latest hospitalization, which was quite some time. Everything was the same, except the floor-length gauze curtains had filtered out a good chunk of the sunlight cast upon the living room, which made it seem dark and depressed.
Youngest Aunt sat on the sofa pressed against the curtains. Her eyes were glued to the phone in her palms, but the phone was locked. As I changed to slippers I could sense that something was off. Youngest Aunt hadn't noticed my presence at all.
The apartment was extremely quiet and I didn't want to alarm her. I approached her gently and called her name. She finally looked over on my third try. "What are you doing here?" she asked after freezing briefly.
"I just arrived. My mom asked me to pick up a few things.
"Oh yes, yes, yes," Youngest Aunt responded. She proceeded to get up to fetch the items in question, only to freeze again halfway. "Do you have work to do later on? Are you busy?" she asked.
I shook my head, adding the plan was to head home straight afterward.
Youngest Aunt then threw me a glance. "Can you stick around for a chat?"
This was the first time in my entire life that Youngest Aunt had made such a request. In the past month, we had hunkered down together in the trenches, which inevitably altered the nature of our relationship. In my eyes, Youngest Aunt wasn't only an elder, but also a comrade and friend. So I took off my jacket, sat down on the sofa chair next to Youngest Aunt's and served her a refill of hot tea.
Youngest Aunt casually mentioned that she had washed Grandma's bedsheets, duvet covers and pillow cases thoroughly in the past few days, then pointed to the balcony beyond the bedroom facing the living room and added: "Look, her comforter has also been laid out in the sun for a few days."
I got the message. "Youngest Aunt, do you want to bring Grandma home?" I asked.
She didn't answer, instead asking: "Do you think she wants to come home?"
Shedding all pretenses, I said: "If we bring her home, who's going to take care of her?"
The response was completely off-topic, but we both knew that any conversation about Grandma's return home who come down to the question of who would take care of her.
Youngest Aunt stared at me for 2 or 3 minutes before saying that she had just gotten off the phone with a friend who worked in palliative care. After getting the lowdown on our family's situation, the friend refrained from passing judgment, simply asking Youngest Aunt: "Is the old woman suffering right now?" After considering her response, Youngest Aunt said Grandma definitely wasn't as comfortable as she'd be at home, but at least she was receiving medical treatment. The friend then asked if Grandma was intubated, whether she was receiving IV drips every day and whether she was using an oxygen concentrator and stuck in bed all day. Youngest Aunt then turned to me abruptly and asked: "That's suffering, no? If we didn't hospitalize Grandma, she wouldn't be intubated, she wouldn't have needles poked into her body every day and she wouldn't have an oxygen mask stuck on her face that prevents her from eating and drinking."
I responded: "Youngest Aunt, if we hadn't taken Grandma to the hospital, she would have been stuck at home with a fever. She would still have to suffer, plus she may not have lasted this long."
Youngest Aunt got emotional. "If she passed away earlier like your Granny, would that have been better? Look at how much pain she's been through so far—and she still hasn't recovered. We're just buying her time."
When she made these comments, Youngest Aunt's eyes were oozing remorse. "Have we been too selfish? We never asked Grandma if she wanted to go through all that hassle at the hospital," she continued.
"Youngest Aunt," I said firmly as I placed a hand on her knees, which were trembling slightly because she was so worked up. "Grandma can't speak or think for herself. We have to decide on her behalf. That being the case, it's impossible for us to see things from her perspective exclusively. We're bound to have our own considerations. You asked if we were being selfish. I don't think there's anything wrong with that. It's inevitable."
I told Youngest Aunt that when I backed her decision to hospitalize Grandma, every single one of my reasons was selfish. I couldn't bear seeing Grandma leave my life, even though it had been 20-plus years since she recognized me. I didn't want to lose Grandma so soon after losing Granny and suffer double the pain. I wanted Grandma to cling on for a few more days, so that my parents could catch a breath. Out of all my selfish reasons, one also had to do with Youngest Aunt. I didn't want her to have spent all this time taking care of Grandma and end up with nothing to show for her effort.
"Youngest Aunt, on the day we took Grandma to the hospital, when you went to sign in, I actually whispered something to Grandma. I said: 'Sorry Grandma, we're being selfish. We can't bear losing you, so we're making you jump through hoops at the hospital.'" Tears started to form in my eyes. "Youngest Aunt, don't beat yourself up anymore. We're not Grandma. We can't suffer on her behalf. And Grandma isn't us. She can't make arrangements on our behalf. We each have our own challenges. It's impossible for us to make the perfect decision. All we can do is try to reduce her pain and make her final days a bit more comfortable."
Youngest Aunt stared at me with a blank expression. A few minutes later, she finally said: "You mean we should reduce her suffering?"
I nodded.
Perhaps this was a bold suggestion that had never crossed Youngest Aunt's mind. She then asked in a concerned tone: "We'll be risking her life, right?"
I told Youngest Aunt that even with intubation, Grandma's days were numbered. "Both are lungs are infected. Her cardiac muscles are severely damaged. Her doctor is saying every day that she could die at any moment. Instead of making her play the waiting game, we might as well..."
Youngest Aunt finished my thought. "Might as well let her enjoy the final few days of her life."
I nodded again. This was probably the last thing we could do for Grandma.
8.
But Grandma never gave us the chance to take her home. She never ended up leaving the hospital before her death.
Youngest Aunt had already reached an agreement with her two older sisters and her brother and her brother's wife. The plan was to let Uncle complete his final chemo session before removing Grandma's intubation after Lunar New Year and taking her home to spend her final days at home with family. But on the second day of Lunar New Year, the hospital called to say that Grandma was critical.
When we arrived at the hospital, we were only allowed to view Grandma's face via videoconference. She was wearing a huge oxygen mask that spanned her chin to her eyebrows. The mask almost obscured her entire tiny face. The doctor said she hadn't opened her eyes the whole day. I called her name in front of the phone, then Youngest Aunt did the same. After a few tries, Grandma actually opened her eyes, staring at us with her bright, black eyes. It dawned on me then that this might be the last time Grandma looked at me that way.
Twenty minutes later, Grandma took her final breath. The doctor said she didn't put up a fight, passing away after a gentle gasp. Great. Finally, my grandma didn't have to suffer.
Youngest Aunt took the lead in making Grandma's funeral arrangements. Youngest Aunt was still suffering from her headaches, so she juggled funeral errands and her own doctor's appointments. Grandma's funeral arrangements also brought Youngest Aunt into frequent contact with Oldest Aunt and my mother. Perhaps because they were still sad, the three sisters stopped arguing and treated each other courteously. Whenever they sat together and there wasn't any conversation, they kept to their own thoughts. When there was discussion, each offered her opinion calmly and rationally. When there was disagreement, Mom and Oldest Aunt simply told Youngest Aunt. "You decide. We'll defer to you."
No matter what, I think Grandma would be happy to witness this scene from above. I hope she can remember her past, remember her children and grandchildren. But sometimes I also hope she has forgotten everything and starts afresh with a blank slate. The fact is, any scenario will do. Regardless of whether she's still my grandma, no matter where she is, I'm content as long as she's free and healthy, as long as she can be the person who roams the world again, the person who no one can hold back.