I awoke to a phone ringing frantically — must have been a Whatsapp call. My father yelling from downstairs: “He passed.” And my mother, opening my bedroom door before my eyes had fully opened, who stood there with her cellphone out, lips quivering, and eyes searching: “He’s gone.” My grandfather had passed away.
The month of December had been tough. Earlier this month, my Nana (Hindi for grandfather) was hospitalized due to swelling in his foot. As hospitals tend to do, they worked him up for everything under the sun. His hoarse voice that he’d had for about a year was now a symptom under scrutiny. Bronchoscopy, laryngoscopy, Foley catheters. Every night (US time) through Whatsapp phone calls with my uncle, my mom would relay the procedure of the day. And every morning, we would listen for the results.
My family knows I am in medical school — but their vision of what I know is very different from what I actually understand. Despite this, pictures of prescription pads and notes, lab values, and X-ray interpretations were texted to us. My father and I exchanged ideas and hypotheses about what could be going on. Just a week earlier, on the road to a family Christmas party, we received a Whatsapp call: “TB?” my mom had exclaimed with exasperation. What on earth. How peripheral edema resulted in a hospital diagnosis of tuberculosis was beyond my comprehension. “Was it really TB…? Was the first thought that went through my head. “Text us the results of the acid-fast or an image of the chest x-ray.” It’s got to be a misdiagnosis, right? But, who am I to question an experienced physician’s interpretation?
My mind whirled with images of the SketchyMicro TB sketch. RIPE therapy of course. He should probably get an ophthalmology appointment before starting that darn ethambutol. But when we got the list of medications he was given, I recognized none of the names. Oh, India. Urimax instead of Flomax. R-Cin for rifampin. Luckily, Google works for translation of pharma names. As the days went on, I kept trying to develop a story in my mind for what was happening oceans away at a hospital in Bombay. They had put my 86-year-old grandfather into an isolation room and told him that “this was so you don’t get infected further.” My mother said he was no longer reading the newspaper, making her extremely nervous. Normally, my Nana would wake up every morning, drink chai and sift through the three different newspapers that arrived at their Bombay home: Midday, Hindustan Times, India Today. His isolation room and his lack of awareness at what was going on outside of that worried me. My grandmother, my Nani, was also worried. He was beginning to lose strength. He couldn’t pass urine and hadn’t had a bowel movement in days. “But it’s just TB,” I said to my mom. “It’s completely treatable.” She was booking a flight to India to help with his care. “No need to rush,” I had said.
That morning, I helped my mom pack for India. The first thing she pulled out of her closet was a white salwar kameez. For the cremation. I tried to be reassuring, “He died of a heart attack. No one could have predicted it.” I think that was more for myself. I couldn’t help but dwell on what I had missed.
It seems that the art of determining severity of a medical condition was beyond my capability. Had I missed something? TB is treatable, right? How severe was it? His heart was doing fine…He had a coronary artery bypass graft 30 years ago, but no real problems since then. Were they related? Or was it the fact that he was in the hospital? So often we hear from doctors that the hospital is the most dangerous place to be. Of course, some of the notion is related to the fact that admission to the hospital is often due to symptoms that are seen or felt, an indication that there was a tipping point in the disease process towards something gone awry. Yet, I couldn’t shake the feeling that there must have been something else. If Nana hadn’t gone to the hospital, and if he had still had this heart attack, he would have lived his last couple of weeks at home … not in an isolation room. The logic in me understands that there is obviously a necessity to impede spread of infection with an individual affected by TB; but what if it wasn’t TB? What if it was a solitary nodule with TB that had just been walled off? What if all of this was unnecessary?
My regret is not seeing the seriousness of it earlier. I don’t know if I could have, but if I missed signs, that is what terrifies me. How do we navigate the waters when a loved one becomes ill? More so, how do we navigate the waters when there are oceans of distance apart and you are interpreting and speculating through secondary data? Throughout his hospitalization, I looked at my Nana’s illness as a solvable puzzle (they’ll probably put Nani on isoniazid, you know, for precautionary reasons), but I never actually spoke to him. I got caught up in the medicine, and even that wasn’t helpful.