First Blows

Sitting on the settee on one side of the large blue painted living room, I watch my uncle Dominic drink from his glass. His throat throbs with the falling liquid. We sit on opposite sides of the room, to maintain social distancing. From this distance, the effect that the Covid- 19 Virus had on his body is made clear to me.

When I saw Dominic for the first time, I was unprepared for what I would see. My mind went to images I had seen of starving people in concentration camps. His legs, thin and bony, shook under his own weight, and his dressing gown hung loose from him in an almost comical manner. His swollen belly jutted out. The image of a child in their father’s clothes comes to mind. When my eyes fall on the scars around his neck, Dominic pulls his gown to the side to give me a better look and I see the thick pink lines etched like tattoos. These scars indicate where for three weeks he had a tracheostomy in his throat sucking mucus out of his lungs and keeping him alive.

For my twenty one years of life, Dominic had been a constant figure of strength. The owner of a gym, he had always been large and muscular, working hard to maintain his high standards of physical health. Before he had fallen ill, Dominic’s body was in the best condition it had ever been, his body weighed sixteen stone two and was able to squat two-hundred-and-seventy kilograms. With shoulders wide and powerful and arms thick as steel girders, there were points when he was close to breaking national records for weightlifting. Strength exuded from him like a gas. This strength, which Dominic had cultivated over years of rigorous training, the professionals at Royal Papworth Hospital attribute to saving his life once he’d succumbed to his illness. Without his training, he would not have survived.

A month prior to his hospitalisation, whenever Dominic would train, a few days later he would feel washed out. Despite the fact that practically, the training was going well, there was an overbearing sense that something was wrong. His movements felt slow and groggy, his urine was the dark colour of aged book pages, his head ached while his temperature soared. It was like a hangover worse than any he had experienced before. Nevertheless, he soldiered on and continued training, whenever these periods of fatigue hit him he’d hit back harder with tougher training and physical challenges. He had unknowingly entered into a deadly game of cat and mouse with the virus which, though his battle was valiant, the virus was determined to win. Like a boxer oblivious to his opponent’s strength, no matter what he did there was no chance. For the following week, irritation rose in him like a flood, and he would snap at provocations which before he would let slide. Something was wrong but there was no telling the damage being done to him. Where weaker people would have fallen Dominic powered through. Could this be an explanation as to how the disease had taken such a devastating hold on his body? His heightened endurance making him more able to withstand it.

By Friday the thirteenth of March, the damage was done. Dominic was becoming repeatedly angry at the fact that he seemed to be constantly misplacing his phone while working at the gym. Whenever he put it down it was like a switch going off and he forgot where he had put it mere seconds ago. Hearing this shocked me as I’d always known Dominic to be composed and mentally sound so to hear not only of the physical side effects of the illness but also of its dramatic effects on the victim’s mental capacity left me with a dry and sober taste in my mouth. With his ire rising to its boiling point, he took the furious decision to set up the “Find my phone” App on his laptop. Typing out the simplest of searches was difficult and Dominic became engrossed in his task, his rage consuming him to the point that he was blind to the other people in the gym. His vision clouded red, then blurred, then darkness encroached.

By a stroke of luck or divination, a client of his, a doctor named Edwina, came to the gym at an unusual time for her. Dominic looked up and saw her come through the red door before the darkness finished its descent. It was at this moment that Dominic became unconscious. Edwina rushed to his aid, when she checked his pulse there was nothing, his heart had stopped. Time was of the essence, she hurried to get him out of the chair and into the recovery position. His large body weighing heavy in her arms, he dropped the final ten inches to the floor which was the jerk he needed to jump start his heart back into action. 

When Dominic came to once more, Edwina took a sample of his blood and told him what had happened to him. Breathless and fatigued, Dominic realised that without Edwina coming at the moment that she did, he would have died. This brush with the eternal blackness was not enough to demoralise him. Recollecting himself and gritting his teeth, he continued to work, overseeing his gym until the day was done. The next day Edwina told him that the blood test had come back negative with Covid-19.

With his health clearly on the decline, Dominic took the difficult decision to close the gym for a week so that he could rest and recuperate. That weekend was spent shivering due to his body’s inability to get warm for which he begins to take paracetamol. Complications mounted and with no foreseeable solution, Dominic was seen by Edwina once more and given another blood test. Edwina leaves him after prescribing a regime of antibiotics and assuring him as best as she could, his body still shaking with the cold that only he felt.

That night, amidst a restless sleep, Dominic experienced the first of a series of dramatic episodes which would cement themselves into his mind in the weeks to come. As midnight passed and the minutes of the night ticked past, Dominic awoke with the need to use the toilet. Dragging himself out of the miniscule warmth of the blankets, he shuffled to the bathroom. The hour kept his vision limited and it wasn’t until he slipped inside and turned the light on that the full extent of the virus’ damage became clear to him.

What he saw when he looked down at his body was enough to make any person’s heart race. The oxygen in his blood had been cut off and from the resultant starvation his skin had turned black as coal. Looking up in the mirror, there was the cold, unnerving sight of a dark figure like a ghost staring back at him, wide-eyed and afraid. The disease had taken a strangle hold on his body and it was clear now that something had to be done, it was no longer possible to go on ignoring the disease as he once had.

The next morning Dominic received a call from Edwina who had taken his blood. Edwina said that he was showing signs of kidney failure and needed to get to a hospital as soon as possible for further testing. Dominic called his sister, Janet to pick him up and drive him to the Luton and Dunstable hospital. Due to the high population of people on lockdown the network servers were crowded and so there was initial difficulty speaking to him. Eventually the message got through and Janet rushed to Dominic’s house.

When she arrived, the man she saw looked more like a zombie than a living person. His skin had turned a mottled grey and his shoulders had sunk deep as if being pulled down. His body was so weak that he couldn’t get into the car on his own and the journey passed in what felt to him as a haze. Twice, Dominic coughed, raising his arm in an effort to shield Janet from the germs. Dominic was obviously sick and Janet knew that she’d be no use if she was as well, so she opened her window and stuck her head out of it to avoid the germs.

When she arrived at the hospital she parked in front of A&E, behind an ambulance. In the back of her mind she knew that she probably shouldn’t have done so but her instincts had taken over and the only thing on her mind was saving her brother. There was no way he’d be able to walk from a car park.

Leaving Dominic in the car, she tried to get into the hospital to alert the awaiting nurses that they had arrived but was locked out. By a stroke of luck there was a doctor nearby who used his fob to open the door. When Janet entered, she saw the room alive with activity. To her left a woman lay sprawled in a hospital bed with a mask over her mouth. Doctors rushed around her. The chaos resembled things she had seen in movies. After telling the receptionist that Dominic had arrived they provided her with a wheelchair and a face mask. While they explained how to put the mask on, she asked if it was for her. The receptionist furrowed her eyebrows and grinned. “No,” the receptionist said, “it is for Dominic.”

Once Dominic was ready, Janet helped him into the wheelchair, put the mask over his mouth, and they returned to the hospital. They were met at the door by a nurse and told that she needed to move her car. Leaving the car park, their younger sister Michelle called Janet saying that she wanted to see Dominic and to wait for her so that they could go together. When they returned to the reception they were told that they wouldn’t be able to see him. Janet didn’t know at the time but, for three months, this would be the last time she saw her brother in person.

Knockout

What followed was characterised by confusion for Dominic’s siblings. Neither Janet nor Michelle knew anything about what to expect or how to get more information. After they returned from the hospital, they met with Stuart, Dominic’s brother and spoke to Dominic on the phone.

Michelle tried to carry on her work the next day but as the hours passed and no news came of Dominic, her anxiety rose. The staff at the hospital remained baffled about Dominic as every test they made gave no explanation as to why he was falling ill. It wasn’t until half past five that evening, when all three of the siblings had heard nothing and were beginning to panic that Michelle made the decision to see him no matter what.

Michelle picked up a set of pyjamas, and some toiletries for Dominic and drove to the hospital. When she spoke to the receptionist to ask how she could get to the High Dependency Unit she was given directions without fuss. At the time it didn’t occur to Michelle just how dangerous it was for her to be there, the only thing she was focusing on was making sure that her brother was safe. Following the receptionist’s instructions, Michelle came to a large double door with the windows inside covered by a white sheet. Her vision obstructed, Michelle peered into the room through a small gap in the covering in the corner of the window where she saw an army of nurses rushing around a figure she could not see.

A nurse came out to see what she was doing and Michelle replied that she had come to see her brother. The nurse seemed to bite her lip as she considered this but soon decided to allow Michelle into the room to see her brother. When she saw him, he was sat in a chair with an oxygen mask over his face waiting for his bed to be inflated so that he could lie down.

Before she could go anywhere near Dominic, the nurses made sure to put Michelle in full Personal Protective Equipment. Stood on an absorbent pad, first a plastic shawl was draped over, then a face mask, this was followed by a blue plastic cap like a shower cap, a long plastic apron, latex gloves and blue plastic shoe covers. Bedecked and armoured, she stepped toward her brother. The nurses who were clad similarly, rushed about checking the monitors and helping Dominic as best they could.

Michelle tried to strike a conversation with Dominic. She asked if he was alright, and how he was feeling. Dominic was a man of many words, a great conversationalist but the disease had made him so weak that he struggled to speak and only managed to get a few short sentences out so Michelle focused instead on making sure that he was comfortable.

Michelle, anxious to help went to her brother and felt that his skin was slick with sweat and hot to the touch. She pressed the importance for him not to cross his legs as it would disrupt his circulation. When this proved difficult she asked one of the nurses to get a pillow for him to rest his legs on. As the pillow was brought Dominic snapped at Michelle to leave the nurses alone.

Michelle ignored this and continued to care for Dominic’s comfort which allowed the nurses to focus on the medical aspect of taking care of him. To address the sweat which drenched his body, Michelle took wet paper towels and gently patted his weak body down to prevent overheating.

When Dominic finally lay in the bed he coughed and turned to the nurse, he told her that he had had an accident. Michelle stepped out of view behind the screen to prevent Dominic the shame of being cleaned in front of his sister.

There came a point when the nurses asked Michelle to help work a monitor by his bed which she did. She was like a civilian during a war forced to work as a medic, she knew the duty she had to help as much as she could and embraced it fully. For two and a half hours she did this, working diligently, before she was told she would have to leave. Before she left, Dominic told her to take everything back with her; his phone, his keys, everything had to go, he thought that he would not need them again.

She was stripped of her protective equipment by the nurses who pressed on her the importance of disinfecting her body. The contact that she’d had with Dominic would be extremely dangerous if she managed to spread it. A sanitising gel called “Nilaqua” was spread over her gloves before she was allowed to take them off and again once they were off. After washing her hands one more time she was told that when she went home, she must wash everything she was wearing and take a hot bath.

Later that evening, Dominic called Stuart and told him that things looked bad and there seemed to be dark times ahead. They were going to put Dominic in an induced coma so that they could better monitor his condition. As a result of these dire conditions, Dominic informed Stuart that he was the executor of his will. This was the moment that Stuart realised the gravity of it all. Dominic was at the brink of death and for him to get back from it would take a Herculean effort. The future was unclear but preparations had to be made for the worst case scenario which seemed increasingly likely. The words which Dominic said on that phone call to his brother would stick with Stuart for the coming months. “Ava gets everything,” he said, even as he prepared to throw himself into the care of others, his mind was focused on making sure that his daughter would be all right.

After his call with Stuart had finished, Dominic called Ava and explained to her what was happening to him. Having to prepare your own daughter for your possible death is an unbearable trial under normal circumstances. It’s impossible to imagine how difficult it must have been without being able to see her in person, to hold her hand, or to wipe her tears.

Three days later, Stuart received a call from the Royal Papworth Hospital in Cambridge. Dominic was being transferred there so that they could put him on one of their ECMO machines because they were unable to stabilise the oxygen level in his blood in the Luton & Dunstable. This emphasised the seriousness of Dominic’s condition. Realising that the days ahead of his family would be the toughest they had faced, Stuart called a meeting of his siblings to decide their next movements. Michelle was on the phone to Janet, explaining what Dominic had said, when Stuart came to Michelle’s door and told her to get in the car. They went silently to Janet’s house, their minds racked with worry for Dominic. In Janet’s living room, Stuart told them Dominic’s condition and said the harsh reality that there may come the time when they would be asked to make a decision regarding’s Dominic’s continued care. Stuart had already made his decision but he needed to know what his sisters thought.

Their response was unanimous. They knew that if there was even a slim chance that Dominic could pull through, then he would. As long as survival was a possibility they would keep on fighting for him, just as he would keep on fighting to be with his family once more. They all knew Dominic’s strength, both physically and mentally, if there was anyone who could survive, it was Dominic.

While they spoke, Michelle received a call from Ava which she took. She wanted support in the confusion she felt, knowing that her father was ill. They spoke for as long as they could but soon it became too much for Michelle and she broke into tears. Stuart took the phone, speaking to Ava for as long as she needed. What do you say to someone when for all you knew their father was dying? This is a question that many of us hope we never have to ask. It is often easy to forget the effect that one person has on others. The tearful months, not knowing what was coming and restricted to one phone call a day which they never knew when was coming. The father, distraught every night knowing he couldn’t do anything to help his eldest son. Ava, Dominic’s child, was so affected by her father’s condition that she needed a lot of support to help her address the emotions which plagued her. It demonstrates how Covid-19’s reach extends much farther than the person it afflicts. The tendrils of disease are longer than anyone can realise.

Back in the Ring

When Dominic arrived at Papworth, that was when the real battle began. They had confirmed that he had the Covid-19 virus, and now the medical staff were going to do everything they could to rid him of it. Compared to the months of struggling which were to come, everything he had experienced before was mere child’s play.

The first thing that the doctors did was to put him on the ECMO machine. ECMO stands for Extracorporeal Membrane Oxygenation, and the machine is designed to work in a similar way to a heart-lung bypass machine. It is used to pump and oxygenate the blood therefore taking the strain off the lungs and heart so that they can be worked on by medical staff, like a spotter taking a weight from a lifter’s shoulder.

In a similar way, he was put on a kidney dialysis to make sure that his blood was being cleaned properly after nearly entire kidney failure.

From the twenty-first of March, Dominic was heavily sedated while the doctors struggled to fight the virus. Two days later they conducted an MRI scan which confirmed that he had four hematomas of the brain, which is when there is bleeding outside of blood vessels, and had several blood clot in his lung on the twenty-seventh of March, an x-ray showed the extent of the virus’s effect on his lungs. They resembled two clumps of fallen snow, pure white, filled to the brim with mucus and cutting off his circulation. To think that this had been building inside him, all while he pushed his body to its limits, is testament to his fortitude.

While the ECMO machine worked hard giving his blood the oxygen it needed, the doctors spent day and night working to clear his lungs so that he could breath once more on his own. On the thirtieth of March, the hospital informed Stuart that they intended to perform a tracheostomy. This allowed them to feed a tube down his windpipe in order to fill his lungs with oxygen. Initially, this tracheostomy was unstable which the nurses attributed to the change in airflow. After years of breathing from his mouth, the new position was uncomfortable. After diligent efforts they managed to claw him back to stability.

From then onward, the condition of lungs began to slowly improve. In deep sedation, Dominic had no way of knowing the extent of the campaign to save his life that the medical staff were undergoing.

For two weeks, steady progress was made. Dominic was slowly weaned off the ECMO machine as the tracheostomy provided more oxygen to his body. Every day his airwaves were cleared of mucus and on the sixth of April he was taken off of the kidney dialysis and able to urinate freely.

Two days later, Stuart had a dream. He dreamt that Dominic had rung him to tell him that he was back in the game and to get the gym ready for reopening. The following morning, Stuart received a call from the hospital saying that they had cleared his lungs of mucus and debris and that he was coming out of his coma. Coincidence or act of prescience, this strange sequence of events was enough to give Stuart a burst of hope in the dark times which he had been struggling in. The weight on his shoulders were immense, having to hear of his brother’s critical condition while also trying to shield his family from the worst of it all. This was much needed news.

For the following week, the good news continued. His eyes began to twitch showing limited consciousness and he was being taken off the ECMO machine for gradually longer times until the eleventh of April when he was taken completely off it. Three days later he came out of the coma and was weaned off the ventilator but put back on the dialysis machine for his kidneys.

From this point they began to test his physical reactions, squeezing his hand to check his responses and trialling CPAP oxygen masks so that he could have oxygen pumped into his lungs without the use of the tracheostomy. 

The progress was slow but reassuring. He started to breath unaided, sat on a chair and awake, for growing periods of time. After a blood transfusion for anaemia, things were finally looking up.

On the twentieth of April, Stuart was called so that Dominic could hear his voice. Things moved quickly after that. By the twenty-second of April, his eyes were opening and he was nodding in response to questions, he no longer require his kidney filtering machine. On the twenty-sixth of April, they started to consider taking him off the tracheostomy and on the second of May, Stuart had his first facetime call with Dominic. Stuart had not seen his brother for seven weeks and the emotional sight did a lot to boost his hopes.

For seven weeks Dominic had been in a coma. Those are seven weeks that he will not be able to get back. Seven weeks in which he has little to no idea the kind of things that were happening to him, the legion of supporters wishing him well on his road to recovery and the feverish work which was being done by the doctors to cure him. Without his strength, he would not have survived. While his physical strength made him able to withstand the disease’s blow, his mental fortitude kept him going. Synapses shooting off to keep him active. He may never know what his body had done in those seven weeks of darkness, but Dominic remembers all too well the work of his mind.

While many wondered if Dominic’s life would end, his mind was creating for him an entirely new life. So came a series of hallucinatory experiences which to the present day, Dominic isn’t sure where the line between reality and fabrication was drawn.

The first of these hallucinations centred around a black woman who was taking care of him. This woman was no-nonsense, living a double life as a drug lord trying to conduct her business within the hospital as she took him around various rooms in the hospital along with her silent sidekick. Another, hallucination saw him in an animated film centred around himself and a group of kittens during the height of the Second World War. Then he led a life as the manager of a funeral parlour.

The most dramatic hallucination, would be the friendship he struck up with a nurse working at the ward he was in. It occurred to Dominic that this man seemed awfully familiar and asked if he knew a friend of his who he’d trained with named Mark Moss. The nurse revealed himself to be Mark’s nephew and the two sparked up a deep friendship. This friendship developed over what Dominic perceived to be several days. When Dominic had finally gotten out of his coma he called Mark Moss and asked him if he had a nephew that worked in the hospital. Mark revealed that he didn’t have any nephews. Dominic had struck up a friendship with a man who didn’t exist.

After these seven weeks, he was transferred back to the Luton & Dunstable, he was still confused after the heavy sedation. Twice he attempted to escape the hospital, the most extreme of the cases being at five o’clock in the morning of the ninth of May. He’d awoken believing himself to be back home and thought that the staff were people who had broken into his house. He called the police and for Stuart to come get him. Stuart snapped at him and told him to get back into bed. After this he calmed down somewhat, though he remained agitated until his release from hospital.

On the twelfth of May, Dominic received the news that his most recent test for Covid-19 had come back negative. The doctors prepared to perform a MoCA assessment to test his cognitive abilities which were steadily improving. On the sixteenth of May, scans revealed that Dominic still had a Hematoma on the brain and a nerve contusion. The MoCA assessment revealed that Dominic’s long term memory was intact while his short term memory was not as effective. His right foot required pain relief and he still required some speech therapy.

On the eighteenth of May, Dominic decided that he wanted to discharge himself from hospital which was inconvenient as the hospital still needed to run some tests. After a call from the registrar, Stuart once again told him to shut up and get back into bed, convincing him to remain a night of tests to make sure that he was fit to go home.

The next day, he was discharged from hospital and taken home. Many believed that Dominic would require weeks of rehabilitation but Dominic had other ideas. From the moment he had left the hospital, he was devising his own physiotherapy routine to bring himself back to fitness. In four days, he was walking unaided by crutches or walking frames. Though it would be many months before he was back to his former strength, the speed of the recovery he has made has been outright miraculous. Without his knowledge of the body and how to build its strength, he would likely have remained bedridden for weeks.