Far away

Kirsten Patrick is executive editor at CMAJ

Yesterday my husband and I took a walk to stretch our legs, keeping our distance from others of course. In one front yard we saw 2 people around our age sitting on camping chairs facing the window of the house where an elderly couple were looking out. The inside couple and the outside couple were talking to each other on the phone, yet being as physically close as was safely possible.

The evening before, I’d talked to my mom (81) and dad (86) via FaceTime. Since I live in Ottawa, Canada, and they live in Launceston, Tasmania, FaceTime is our usual mode of communication. I haven’t seen them in person since my mom’s 80^th birthday in January 2019. They’d been planning to visit us in Ottawa in May.

On March 21^st my brother, a physician who lives in the same town as my parents, called me. “Could you talk to Mom? She is still going to the shops.”

Before Canada closed its borders and international air travel shut down, Mom was still saying maybe they should just come visit us anyway. This even though I’d made some effort to explain that, because she has heart failure and a pacemaker and is also the eyes for my all-but-blind dad, she really shouldn’t risk exposing herself to the virus. I know I’m not the only one who has struggled to understand why some elderly parents are so reluctant to alter their behaviour even when informed of their heightened risk of death from COVID-19. I hadn’t wanted to say to her, bluntly, “Mom, if you get the virus you’re absolutely going to DIE so stay the hell home!” but perhaps I should have.

Anyway, at my brother’s request I called Mom to talk to her about not going to the grocery store.

“But how will I get things?” she said. She doesn’t like to be an ‘inconvenience’ to others even if they are family.

“You’ll call Andrew, give him a list and he or the girls will shop for you.”

“But then I’ll need to go and get money to give to them.”

“Mom! Just e-transfer the money to Andrew or give him your card. Nobody is taking cash anymore.”

[Long Pause]. “Okay.” The same kind of ‘Okay’ I hear when I tell them not to try to give us money for groceries when they come to stay. It means ‘I’ll think about it but not for very long and thinking about it probably won’t change my mind.’

But the next time I spoke to Mom she told me about the system she and my brother’s family had worked out for contactless grocery purchasing and delivery.

Perhaps some authoritative messaging from their GP did the trick. The organization of seniors’ care in Tasmania has always impressed me. Mom told me that their GP (proactively) arranged a telephone consultation with her and my dad separately to check if they had any health concerns and to establish mom’s need for medication, which she then arranged for the pharmacy to deliver. No doubt their GP also took the opportunity to give them advice on how they should isolate from others. This was a much better and more caring experience for my parents than some stories I’ve read, about UK GPs sending letters to older adults in their practices requiring them to sign DNR forms or overriding them if they refuse to.

Mom told me they wash all their groceries carefully as soon as they bring them inside, that they don’t interact with anyone else and that they go out for short walks twice a day (sanctioned by their GP). I heard this with some relief. They live in a super-quiet neighborhood next to a large suburban park where they’re unlikely to meet others – or at least are able to bypass others at a 50m distance – if they take a short walk. Dad would not cope at all without the walks. It is the way he gets to feel a sense of independence and control over his visually-impaired life. Their GP knows this.

I miss my parents now more than ever. Living a 25+ hour flight away from them there is always the possibility that I may never see one or both again. We live with that reality and we cherish the rare times we can visit in person. Yet the shutting down of international travel due to the pandemic, and the fear that they might put themselves at risk of infection with SARS-CoV-2, has intensified the missing. I understand why the people that we saw on our walk yesterday would choose to sit outside their oldies’ window to talk by phone, rather than just Facetime from their own home. I’d love to do be able to do that myself.