Failing to survive COVID in Lebanon
I spent 2 weeks with my mom in an Intensive Care Unit on a COVID floor and witnessed first-hand the dark reality that Lebanon is barely living and the ugly path it is going down on.
My story is not unique, actually many Lebanese people have lived it and are continuing to live it and that’s what is so scary. The deadly impact of the COVID virus has impacted almost every household in Lebanon. If you ask the older generation (Tetas and Jiddos), they will tell you that they lost more beloved people for COVID than they did in the brutal civil war. Let that sink in a bit.
I am one of them. On April 9th, 2021 at 1:55 am, my mom passed away and was one of the 43 registered COVID death cases in Lebanon on that day.
At the time of starting to write this, April 15th, 2021, Lebanon registered almost 502K cases and 6,778 deaths. With a population of around 6.9 MM, this means 7.2% of its population has been impacted. In reality, this number is a lot higher given that very few get tested in Lebanon especially that certain areas don’t enforce the mask mandate, for instance Tripoli. Although its people are some of the sweetest and caring people, they still believe COVID is a hoax and a conspiracy theory.
My mom was admitted into the hospital the day before Mother’s Day, March 20th. Before I walk you through the hospital experience, it is important that you have some background on my family story, which is similar to many other Lebanese families.
Background
My parents got married at age of 19 and lived in Sahit el Amarkan, Ibeh, Tripoli. Both of my parents dropped out of school at early age, maybe made it through 3rd or 4th grade. Highly intelligent individuals but at the time, education wasn’t really a priority. Instead, the priority was to create a family, a big one, work and provide for them and give them the best life. That’s exactly what my parents did. Mom was a housewife and house manager, and Dad was the provider. Dad travelled a lot the first 10–15 years of their marriage and coincidentally, my parents had all of their kids within the first 16 years of their marriage. The first at age of 20 and the last, yours truly, at age of 36. He will be home for some time to check on mom and the kids and travels again and by the time he comes back, there will be an additional kid waiting to meet him.
This is one of the many amazing virtues that mom had. She delivered 4 out of her 5 kids alone without my dad including one that she delivered completely on her own while picking up vegetables in the field. I was the lucky one to be born in the hospital. She never had a maid or help. She cooked, cleaned and raised a family pretty much on her own.
In 1982, during the Lebanese civil war and while I was few months old, my parents left everything behind in Tripoli and fled to Bsarma El Koura, a village in the suburbs in North of Lebanon. In Bsarma, we built a new house that became our home for the last 39 years. Mom and Dad would tell us crazy stories of the war, the night they fled, the snipers, the dead bodies they stepped over and many more that were disturbing but also a part of history that we felt shaped us.
From the beginning, Mom and Dad had one goal in mind for their kids. Education. Mom would say: “This is your weapon; you will conquer the world with it”. We all believed her although you come to think about it, how did my mom know? She never got the full education; how did she know that this is the top priority? I don’t know. All I know, my mom was our guardian from the day we were born to the day we graduated and made sure we excelled in our studies. Although Mom didn’t know how to read, she knew when we make a mistake in reciting a poem or reading a lesson. She was this good, you couldn’t trick her.
Years after, she has 4 boys and a girl with advanced degrees in engineering and medicine. That made her so proud. You should hear her bragging about her kids, grades, education and work in front of others. She might exaggerate a bit at times, but she was so cute. It was adorable, the amount of pride she had knowing that the long nights, the tough times and the struggles she went through led to having a family of educated and accomplished kids was all worth it. Talk about selflessness.
Here is where my parents have so much in common with other Lebanese families. Not only that they had to migrate during war, live a humble life, but also grow old alone as their kids leave Lebanon looking for job opportunities and work. In our household, 3 sons migrated to the US, 1 son migrated to UAE, and the one daughter migrated to Australia. Mom and Dad were empty nesters since 2006. We tried to bring them closer to us. My brother even went through the painful process of getting them a green card. We didn’t think that they will go the entire way and get a foreign passport but at a minimum be able to maintain the status of the American Green Card which is entering the US at least once every 6 months. Two years later, Dad went to the US embassy in Beirut and dropped off the green card and asked them for a Visa instead. He literally gave it up because travelling twice a year to the US was too much for them. This was a decision that we regret them making, a decision that changed the course of things for everyone especially Mom.
The Nightmare
My parents came to the US for a visit in November 2019, stayed few months and head back to Lebanon early January 2020. Thinking back, I am so glad that they came because that was the only time that mom has met my son.
At the time, we didn’t even know what COVID was and what it will do to the world in just few months after. If we did, we would have never let them go back. As the news and severity of COVID became surreal, Mom and Dad took good precautions. They confined to a small circle of family and friends and up until March 2021 stayed COVID Negative. Frankly, I never worried about my parents with COVID even though both of them have a long list of medical issues especially Mom. She is overweight and had numerous heart attacks and heart procedures over the year. My parents went through a lot and they already live a pretty isolated lifestyle so they will get through this COVID lockdown just fine. This was true until Mom’s brother was on his death bed battling liver and kidney failures for some time. My uncle was a heavy drinker and it caught up to him. He was in his early 70’s but quickly deteriorating. Mom visited her brother one last time in early March, few days before he passed away. The details of the visit, around who she saw and interacted with, are not very clear but what we know is that Mom caught COVID at that moment and a significant dose of it.
Following that visit and the death of my uncle, COVID started spreading across the family. Two Uncles tested positive, Mom and Dad tested positive, my cousins and their kids tested positive. Around 23 people within the family tested positive. The nightmare of COVID has become our reality. Within days, one of my uncles got admitted into the hospital as his oxygen levels dropped under 90%. My uncle was the lucky one and for 2 reasons: 1) we were able to find him a bed in a hospital. This is at a time where the COVID cases were surging. 2) he went in at the right time before COVID took over his body. My mom wasn’t the lucky one.
Stubbornness runs in our family, combine that with resilience and independence and you get Mom. She never wanted anyone to worry about her. She never wanted to be a burden on anyone. From the second we knew Mom had COVID, she went into isolation and my brother, the doctor in the family, started monitoring her remotely. Oxygen levels and body temperature every few hours, calling 5–6 times a day to check for symptoms and mom seemed to be holding up well. Except mom wasn’t telling us the full truth. Her oxygen levels were dropping under 90% at night, she had nausea and was getting weak. She even missed the bed one night on her way back from the bathroom. On March 20th, an ambulance rushed my mom to the hospital to the same bed that my uncle occupied for the past week. The only bed available to us in the whole country was the bed that my uncle just checked out from. My mom was admitted into the COVID floor on the day before Mother’s Day.
Twenty Days Fighting
At the time of admittance, a CAT scan on mom’s lungs showed 80% damage by COVID. COVID has spread too much into her lungs. Our goal now was to keep mom healthy and alive while her lungs recover. We knew time wasn’t on our side. The longer she stays in the hospital, the lower is her chance of survival. No matter what happens, we wanted to stay away from the ventilator. My brother, the doctor, kept saying: “The second she bites the tube, her mortality rate goes up by 20%. Simple complications can be deadly. We need to keep her away from the ventilator”. Within the first week, 3 of her sons were by her side, including me. Although only one of us, my doctor brother, was able to help; we were there to boost mom’s moral and we like to believe that we did.
It quickly became clear to us that the fight was not only against COVID. On one front, mom was fighting for her life and on another front, we were fighting to get mom the medical attention she seeked. This is where it became clear to us that the longer that mom stays in the hospital, the worse things were going to get. Let me describe to you the hospital situation because it is very much unique to Lebanon:
Mom was in the Intensive Care Unit (ICU) on the COVID floor. You can barely differentiate the normal room from the ICU room on that floor. I want to believe that the ICU rooms had better equipment, dedicated staff and more sterilized but in reality, they were all the same.
In normal circumstances, COVID patients are 100% isolated with no contact with the outside world. Not in Lebanon, luckily, if you know the right people you can still go in and out of the COVID floor during and outside visiting hours. We tested our vaccine hard and luckily didn’t catch COVID given how much in contact we were with it.
There is a serious shortage of medical staff in the country. Nurses, Assistant Nurses and Doctors are fleeing the country. They are not scared of COVID but they are worried that they won’t be able to provide to their families as the state of the currency continues to sink. Prior to the economic crisis and COVID, a nurse at a decent hospital would get around 1.2 MM LL a month which at the time equated to about 800 USD. You can’t compare this to the salaries in the US but for Lebanon, it was ok. Fast forward to now, the Lebanese currency has lost so much of its value that the 1.2 MM LL equates to less than 10 USD. How do you survive when everything around you got so expensive, but your salary stayed the exact same? You simply can’t, so instead people are leaving to the first offer that gets them out of the country.
The medical staff left is not equipped to handle such crisis. There is no ICU doctor, in some cases you get an orthopedic or a surgeon to cover the ICU floor. Not only that, but they are also fresh grads. Some of the doctors we met have only been doctors for the past few months. Talk about being thrown into the wild.
Due to economic challenges and the dive that the Lebanese currency have taken, there is an unprecedented shortage of medicine and medical supplies. It is actually puzzling. Imagine you are in the hospital and the nurse comes to you asking you to go get your mom a certain medicine because they don’t have it. So off you go from one pharmacy to another searching for this medicine. Less than a week in the hospital, mom had a massive heart attack. Thank God that my brother was present to diagnose it or otherwise that could have been it for mom. As my mom was having the heart attack, my brother asked the staff for nitroglycerine. Nitroglycerine, as far as I understand it, is a pill that you can take under your tongue to help open up the arteries in the heart which could save you during a heart attack. Yup, it is something you want to have handy when you have a history of heart issues. Well, the entire country didn’t have it on that day. Not the hospital, not the pharmacy, No one. Luckily, mom was rushed into a cardiac procedure that opened up the struggling artery and survived.
We hired a dedicated nurse to care for mom in the ICU unit. It sounds counterintuitive to hire a dedicated nurse for someone in a hospital but when the staff is limited, and you see first-hand that your mother’s health is deteriorating because of it, you start looking for options. Do you move her to another hospital? Well, we don’t know if the other hospital is going to be better. Time was running out and options were limited. The only thing that brought us some peace of mind was having someone by mom’s side every second of the day.
WhatsApp is everything in Lebanon. I don’t even know where to start. We did everything over WhatsApp. I had the doctors, nurses, family, friends, work and all communicating through it. Shoutout to how Lebanese people figured out ways to get the most out of it. We couldn’t be with mom 24/7 but we hired a team of dedicated nurses that cared for her around the clock. Every 30 mins, the nurse will send us, through WhatsApp, a picture of her vitals (Oxygen Level, Heart Rate, Blood pressure, Respiratory Rate) and the settings of the oxygen sources. Every morning, we will get an updated chest Xray, blood work, cultures and others on WhatsApp. At times, things got out of control and WhatsApp saved the day. For instance, the day my mom went on the ventilator. The first half of that day, I was communicating with my doctor brother in the US and getting his messages and recommendations to the staff through WhatsApp voice notes, calls or video calls. I was the guy walking around with the speaker on his phone hauling the nurses down to find the doctor to talk to my brother. Surprisingly, the staff listened really well to my brother and went along with his recommendations. As much as I hate Facebook and their entire business model, I love WhatsApp and how it is being utilized in Lebanon especially in situations like this.
Electricity is a privilege even at hospitals. I have been in the US for over 20 years and I think I remember all the times that we lost electricity. In Lebanon, I don’t remember a day passed without seeing the electricity flicker and go off. Nothing prepares you to see electricity going off at hospital in a COVID ICU room. It happened at least twice a day. Luckily, the important machines had their own backups so they could operate for some time until the electricity switched back but still. Every time it happened; I couldn’t help it but think what would happen if any of these machines fail. Would mom survive? What kind of panic would we go into? It is not paranoid; it can happen but thankfully it didn’t.
The last 24 hours
Mom got on the ventilator on Wednesday. I was the only family by her side when this happened. I truly believed that this is temporary, and she will wake up from it. If you don’t know this by now, you are 100% sedated when you go on the ventilator. Actually, they can’t fully sedate you as they need your body to acclimate to the tube, so you are 80% out but there is a chance of you waking up. The scariest thing happened to me when my mom woke up out of her sedation. It happened twice. Both times, she wanted to scream but she couldn’t. The tube blocked it. She wanted to pull it off and that’s where I had to hold her and calm her down. The second time it happened, tears were flying down from her eye as she looked at me. That was the moment mom gave up. I believe mom saw herself beating this and walking out of the hospital until she saw herself on the ventilator. I can’t describe that moment. I feel she looked at herself and she saw that it was time. The tears she shed were almost like her feeling sorry for herself and the situation that she might have put her family into it. The selfless mom, even at that moment, didn’t want to be a burden. That night, I slept with my mom in the same room. A bit crazy but I feel so lucky to spend that night with her. The nurse that shared the room with us that night and kept a close look at mom was so sweet. When she went on her break, she came back with a Labneh Sandwich and a 2-in-1 Nescafe. She didn’t have to do that but nevertheless, it was sweet. Wednesday night into Thursday was uneventful. The oxygen levels were stable, heart rate a bit high but ok, blood pressure good. We all felt good about this and optimistic that with mom resting, her body will recover faster. As we entered 1 pm Beirut time, things took a bad turn. A lot happened but the most noteworthy one was her blood pressure. It started dropping and dropping rapidly. My brother, in the US at the time and over WhatsApp, talked to the doctor and requested a central line into the artery. This will allow us to get a real-time reading of her blood pressure. With real-time read on the blood pressure, you can see how quick blood pressure can drop. It was like the stock market crashing in front of your eyes. As blood pressure drops, organs stop to function and that’s where you run into organ failures. In hopes to avoid this, we flushed fluids into mom and started injecting Levophed.
Levophed is like adrenaline, it is used to treat low blood pressure. It was like magic, at one point her blood pressure was as low as 60/40 but once the drugs kicked in, it started going up. The goal was to get her above 90 and best above 100. As it increased, I snapped a pic and sent it to the WhatsApp group between my brother, the nurse and myself. It was the best feeling I had in the past 2 weeks. I felt good. She went above 80, above 90, above 100 and all the way to 130/80. We did it. She is stable. I wish it was this easy. Her blood pressure was in good shape now, mainly because of the drugs, but she has almost 3 liters of water in her and we see no urine. I stared at the bag connected at the end of that Foley Catheter for hours. I remember my brother saying: “we need 20–25 cc every hour”. In 2 hours, we didn’t see a drop. It wasn’t a good sign, this meant that the kidney failed. According to the doctors, as long as the kidney hasn’t stopped working for more than 6 hours, then there is a good chance in seeing it kicking back in. Unfortunately, it never did and the bag stayed dry.
By now, it is almost 10 pm. We ran another round of blood work and blood gas tests. The results didn’t look good. I don’t remember which one it was, but it was supposed to be between 0 and 4 and it came back 4000. The inevitable happened, the liver is shot. Mom had a septic shock. The blood pressure dropped too low followed by an infection. Lungs, Kidney and Liver are gone. We are out of options. The doctors that we got to know over the past few weeks came into the room and pretty much said that they did everything they could but with a multi-organ failure, things didn’t look good.
It was midnight now; I didn’t want to hear it. My oldest brother is with me in the room. The rest of my brothers and sister are on standby on the phone. I felt so helpless. I needed a breather. I left the building and went outside. The valet drivers had a fresh pot of coffee. I borrowed a cigarette and a bitter cup of Lebanese coffee. I sat out on the curb overlooking the Mediterranean Sea. It was dark out; it was late and there was barely anyone out. I smoked the cigarette and cried. I called my sister in Australia and we wept together. Then I stopped and reminded myself that mom is still alive. Why are we crying? Mom is still alive, so I went back to the room.
On Friday morning, April 9th at 1:55 am, I was by my mom’s side as I saw her blood pressure freefall, her SpO2 levels drop, and her heart rate go down to 0. Her forehead was boiling but her feet were ice cold. I saw my mom’s skin color fade away as if her soul just left her body. Up until then, I have never seen anyone die before. It is a horrible sight. It is a very lonely moment. You feel so helpless.
Everything after that moment hurt. Calling my brothers to tell them that I couldn’t keep mom alive for them to see her one more time, telling my dad that his lifetime partner of 55 years is gone, telling her younger brother who barely survived COVID that she is no longer with us. I felt that I failed them all.
My story is my story but it is also the story of many in Lebanon. I cried for mom, I cried for the country and I cried for the people left there. I don’t know what is next for Lebanon. I don’t know what will happen in the next 6 months but if things continue like this then we are doomed.
