Evening shift. I stare at the computer screen, frustration and mild panic rising within me. Maybe if I look for long enough the Tetris game of too many patients and not enough cubicles will magically rearrange itself. Space. We need space. There are six ambulances ramped, and the waiting room looks like the Jetstar counter after a computer meltdown. I turn to the nurse in charge sitting next to me. “Surely this lady can go the ward, she’s been here 13 hrs?”
“Gen med saw her and decided to flu swab her, but there’s no single room.”
Another one in the purgatory of “awaiting flu swab”. Can’t be cohorted with other flu patients because might not have it. Can’t go to a non-flu room in case they’re contagious. So they’re just going to hang out here with us. Flu season is ruining my life.
I leave work late and arrive home in the still of the night, winter air crisp, stars sprawled with abandon on the inky night sky. I can just smell the sea. As I enter the gauntlet of multiple gates, carefully navigating around discarded bikes and poorly tended pot plants, I am greeted by an embarrassing number of dogs, carelessly high, more than we ever intended to have.
When I work late, I am a ghost in my family’s life, arriving wordlessly in the dark, silently moving from room to room, counting heads and checking that everyone is still breathing. Will I ever stop doing this? We are five in our house, and come in categories. The grownups, then the big kids who go to school, and finally a toddler who walks and talks and causes mischief but will be the baby until he’s left home and possibly beyond. And the animals, along with the dog pack, there’s a couple of impulse-purchased yellow canaries, who are very pretty but fairly useless, and four-but-one-died makes three chooks. It’s a small house but we make room for everyone, albeit with little built-in redundancy. Guests currently have a choice of the fold out sofa, or bunking in with the toddler. Most choose the sofa.
Then, three doors down, lives my mother in law. Nan. She’s an accessory to our family, her house a small colonial outpost. Its’ close enough that the big kids can wander down independently for Foxtel and Nan-house specific treats, such as shortbread and a particular brand of frozen yogurt sticks,
Nan shifted from her life-long home in the big smoke three years ago so she could be near us in her older age. She bought her dog, Mia, and the two settled in to continue living in utter mutual devotion. When nan strolled up to our house for Sunday morning pancakes, Mia, powered by the dual advantages of youth and extra lower limbs, would run ahead, and when a fluffy, white spoodle started scratching at the side door, we knew Nan would appear shortly, leading to the family catchphrase, “Where there’s Mia, there’s Nan.”
I love that my kids have a Nan down the street, but it is not always utopia having a mother in law living three doors down. She was born the year before World War II and raised her three children in the 70s. We are of different times. She has strongly voiced opinions on all aspects of her daughter in law’s life; how I hang out washing (wrong), how much I work (too much), how my husband has to pack his own clothes when he goes away for fishing trips with the boys, (what can I say, I’m a feminist witch keen on bringing down western society), and how I settle the baby, (bottle of warm water with a bit of glucose would do the trick). She expresses these as a statement of fact, without venom or malice. She holds no grudges and if we bicker, she doesn’t sulk. We have our own little rituals. Sometimes, after the kids are in bed, I bring her some dinner, and find myself there an hour later, sitting on the couch next to her and Mia, companionably eating shortbread and watching Call the Midwife. She no longer drives and hates being dependent upon us as a chauffeur service, yet my favourite time is when we’re in the car together, when she opens up about her life. It wasn’t always easy. Her mother died when she was 15. No one told her it was happening, she just went into hospital and never came home. After that she went to live with an older sister, who had a young baby die of cot death. Nan was there when it happened, still a teenager. She had two late term miscarriages. I would never have known all this if we didn’t need to drive places.
A few weeks later, I’m back at yet another evening at work, this time in my shiny, well resourced, private department. The ward clerk comes and tells us there’s a kid out the front who “doesn’t look well”. The triage nurse heads out to fetch him while I prepare resus. She’s an experienced nurse, straight talking and unflappable, and as she hurries in, followed by a mother with babe in arms, her face is scared. We put the baby in the cot. Good god, he is utterly flat. He is roasting hot, tachycardic, tachypnoiec, and just looks so damn sick. Two hours later, after antipyretics and some fluid he looks much better, and the flu swab comes back positive. Bloody flu, you got me again.
The media is filled with hyper-excitable headlines about the “horror” flu season, the death toll reported breathlessly. There are case reports of awful untimely loss. A young father from the country, a child in Queensland. Parents bring their children in to ED, and are bewildered and a little horrified that we are sending them home. But it’s flu! Flu is very serious. It’s hard to get the dual message across sometimes. FLU IS VERY NASTY AND FLU CAN KILL SO PLEASE VACCINATE! (But in most people flu will be an unpleasant but self limiting illness that can be safely treated at home.) There are urgent notices from school and daycare that there have been “Cases of flu.” Work or home, it seems I cannot escape flu.
Winter is not kind to families with multiple children, and we suffer a run of the usual daycare coughs and colds, but avoid the dreaded F word. I feel somewhat smug, wrapped in the comforting cocoon of our fully vaccinated state. (disproportionately smug, given the known limitations of this particular vaccine.) I treated so much flu, but haven’t caught it yet. Surely we’re on the home straight here.
The fever that heralds the start of our demise is more inconvenient than alarming. It’s the last day of school holidays, and the grownups are itching to return to normal routine (and childcare), when the middle child takes a turn. The next morning he’s flushed and lethargic, with a headache and sore throat. No school for hjm and I reschedule my day. Two days later my husband wakes up shivering and drenched in sweat. We analgese and and Keep Up Fluids and sit it out for a few days, but the sick child gets worse, not better, and a swab confirms flu A. Two down. That day my son is too sick to have the TV on, and at bedtime, for the first time in his life, he declines to have a story read to him, he just wants to lie there. He ends up missing a full week of school, and husband’s work comes to a standstill.
Exactly one week later, as the boys are turning the corner, I receive near simultaneous calls from school and daycare. Our daughter is in sick bay, and the toddler has woken from his nap with a fever. Four down. I start composing a country music style song, “My whole family has Influenza A.” It feels vaguely apocalyptic.
Anyone who has ever cared for a sick toddler knows there is no such thing as infection precautions. They love wet, open mouthed kisses. They will cough and sneeze on your face, and pick food off your plate with snot covered fingers. We bulk buy tissues and hand sanitizer, but it is like fighting in a war with a Nerf sword. And as expected, a few days down the track, after a vague, non specific prodrome, I wake up proper sick. Last woman down.
Oh dear, they weren’t lying, flu is awful! Everything hurts so much. Why does my back hurt? After two days I feel so shocking I go to the GP, as if it’s not the flu I’m clearly dying. I completely understand why grownups would present to ED feeling like this. I’ll end up having ten days off work, and it will be three weeks until I am fully recovered, and this alone would be a significant event in my year. Except as I hit my nadir, Nan gets a fever.
The event that initially had triggered Nan’s move to our street three years earlier was a cold night on the floor in a urine-soaked nightgown. She had fallen and there was no one there, her alert alarm safe and cosy in its home on her bedside table. After she moved, we realised that while she was “independent with ADLs”, she needed assistance with many other aspects of living; opening jars, dealing with government bureaucracy, changing gas bottles, trimming her toenails, stopping the healthcare system accidentally killing her etc. If you put tasty food in front of her she would eat it, but had long lost the motivation for food organisation and preparation. With her close by, we were able to easily give the type of real time, piecemeal care that is very difficult to outsource to “services”.
But it was more than that. We cared for her and we cared about her. We were invested in her health and wellbeing. We gave a shit. And if there is one thing I have learned, in medicine and life, it is this. If no one gives a shit about you, eventually you will wither and die. The flip side is infectious diseases evolved and thrive in such familial social networks, ruthlessly picking off the vulnerable and now our flu had spread to our Nan.
Humanity and influenza are inextricably intertwined. It’s been with us for at least 10 centuries, and kills over 250,000 people every year. It shreds the lining of the respiratory tract, leaving you vulnerable to secondary bacteria pneumonia, the cause of many deaths. 100 years ago, the Spanish Flu killed between 3 and 5% of the global population. It’s abundantly contagious, spreading with ease, by aerosol or direct contact with respiratory secretions, through families, daycare, schools and workplaces, anywhere people gather together. It got my whole family, but now that Nan is sick too, we are in different territory. The illness that had been unpleasant in the young and robust now feels vicious, malevolent, like an annoying neighbour nobody likes who it turns out is actually a serial killer.
An ambulance is called and my husband accompanies his mother to hospital. I lie on the couch feeling sicker than I ever remember. The big kids are improving and are quite happy to indulge in unlimited screen time, the toddler nestled comfortably between them. My colleague phones me from the ED. He tells me he is very concerned about Nan. He repeats that phrase. He is very concerned. This time I get it.
Family are summoned, I drug up, don a duckbill mask and drag myself in. The moment I see Nan, eyes dull, breathing moist and ragged, I know she will not come home again. Three days later she dies. It is a good death. There are no heroics, nothing silly. Just love and care and crisp, white sheets.
The month ticks over. The days are warmer and pink and white blossoms are sprouting, heralding spring. We have all bounced back, and the whole episode feels a little surreal. I read the latest flu death tally in the paper, knowing Nan is now included. I wonder who the others were. Who loved them, who misses them.
There is no Nan for Sunday morning pancakes this week. But there is a little white spoodle, curled up on the couch as if she owns the place. Mia came to live with us, of course she did, there was never another option. A fluffy, canine legacy of our Nan down the street. Where there’s Mia, there’s Nan.