One sweltering afternoon in Seoul several years ago my mother and I walked to the end of a dark, concrete hallway and paused in front of a familiar metal door.
As children, my brother and I had spent many afternoons playing outside that apartment complex. We would run home from the playground when the sun sank below the industrial skyline, ravenous with hunger. Our grandmother would always be there to open the door for us, the rich aroma of her chicken stew overflowing into the hallway.
Twenty years later, as I stood in front of the same door, now splashed with rust, memories resurfaced like light piercing through pinholes. My grandmother had always encouraged me to study medicine. She frequently told stories about the Korean War, which she and her eight younger siblings survived because a physician relative took them in.
When I left for the United States at age 10, I promised to study hard and work toward becoming a physician. Nearly two decades later, I wanted to tell her I kept my promise. But she had also changed, developing dementia that made her behavior unpredictable.
“Don’t be upset if she refuses to see you,” my mother warned me.
I was anxious, but optimistic. How could she have forgotten me?
We called first from outside her door.
“Who are you? What grandson? I don’t have a grandson. Are you trying to take my money? Go away!” she said, then slammed down the phone. We kept trying, but could not get her to open the door.
After 20 years, I was a stranger to what had been a place of warmth and safety. Words could not open the door to her apartment or her memory. I walked away in disbelief.
At the end of the summer, I flew back to Philadelphia to begin my eight-year residency in cardiac surgery. A year later, my grandmother had to go to a nursing home. I have not seen or spoken to her since.
When the coronavirus pandemic started, it was evident early on that older patients were particularly vulnerable. As the death toll from COVID-19 exceeds 200,000 in the U.S, approximately eight out of 10 are in those older than age 65.
Part of the reason is that the elderly are medically fragile, but that can’t explain everything.
What if some of it is due to social attitudes? Consider the discussions over fair and ethical allocation of ICU beds, ventilators, and hospital staff. Some asked, if elderly patients fared so much worse, shouldn’t younger people with a more favorable prognosis get priority?
What if it’s because we are starting to grow complacent about the pandemic, forgetting about those we have already lost?
President Donald Trump recently said at a rally, that the virus only affects “Elderly people with heart problems and other problems.” But, he added, “That’s it … nobody young. … Take your hat off to the young because they have a hell of an immune system.”
As we face the highest surge in COVID infections to date, the administration has repeatedly downplayed the pandemic.
At the hospital where I work, several new intensive care units were set up in early spring for COVID-19 patients. My colleagues and I spent several months covering the 12 beds in one of these units.
Most of our patients were from nursing homes. They were generally in their 80s or 90s, and many already had heart, lung, or kidney diseases. Most required ventilators. They were easily confused — none understood just how ill they were — and generally frail.
One gentleman in his 80s had a particularly severe form of dementia. He was my very first patient in the unit. From his labored breathing and grimacing, I could tell he was feeling short of breath and was in pain, but otherwise he couldn’t communicate other than to try and bat me away when I cared for him.
Just as soon as we would position him so that his monitoring devices and his oxygen mask were working appropriately, he would take his mask off causing his oxygen level to drop and set off an alarm. This happened constantly, endangering him and all of us, given the risk of transmission.
I sometimes thought about just leaving him be. If all he understood was his discomfort, why would I keep inflicting it on him when other patients needed me?
Then I remembered my grandmother, how I had walked away from her that sweltering afternoon in Seoul. I told myself that her dementia freed me of any responsibility to remedy our relationship. But the more this patient tried to push me away, the more I wondered if I had given up on my grandmother too soon.
It is easy to give up on a hopeless situation. It is easy to forget what we have already lost. Giving up lifts the burden of responsibility from our shoulders. So, we tell ourselves many elderly patients have died and will continue to die from COVID-19 because they are too fragile and old. Their mortality is becoming a statistic that no longer seems to raise an alarm.
But what if the coronavirus not only created new problems for frail, elderly patients, but is also exposing the problems that were already there? What if we all need a reminder to care more about the most vulnerable during this pandemic?
Many of them may have been forgotten by society well before the pandemic started. Too many nursing homes — especially those that serve the poorest patients — have long been sites of long-standing, widespread neglect. They were poorly prepared to control infection with as many as four residents sharing a room and bathroom.
Some of the patients we admitted due to COVID-19 had signs of neglect. Some were sick from other treatable, preventable infections that made them too weak to fend off the novel virus. Some patients' charts had no family members' phone numbers, so we could not call their loved ones, nor did they have instructions for proxy decision makers.
As COVID-19 continues to claim more lives, especially those of the elderly, we need swift action to aid this population. We can no longer rationalize that these patients are beyond rescue.
Much as I would like to blame dementia for taking my grandmother away from me, I now understand it was I who failed her through years of silence. Caught up in my busy schedule, I rarely called her, at most once or twice a year, and only at my mother’s insistence.
Even as I studied medicine, I failed to notice the early signs of her disease, her once beautiful penmanship gradually deteriorating each year on the birthday cards she still managed to send. Now, during the pandemic, there is little I can do to communicate with her, let alone to be by her side in South Korea.
As a physician, I have watched too many families arrive at the same realization, that they could have done so much more to reach out to their loved ones before it was too late.
I still wonder how I would have felt if she had opened the door that afternoon. I had left behind everything I had known as a young child to pursue a distant goal, one that I had finally accomplished. Would she have been proud? Would she have forgiven my silence?