One of Our Own’s Covid-19 Journey from Ventilator to Back Home

By Lisa Grey

Houston: In early March, Susham “Rita” Singh, then 65, took time off from selling appliances at the Galleria-area Home Depot. Her husband and her daughter — a doctor — yelled at her, warning her against flying to India for her annual visit with her mom. This new coronavirus was wreaking havoc in other countries, and airports and international flights seemed a bad idea.

But Rita’s mom was 90, and really, how dangerous could the trip be?

Rita flew back to Houston on March 21. On one of her flights, someone coughed a lot.

Home Depot required her to quarantine after the international trip. She did it reluctantly: She loved her job, loved the store’s hubbub, loved talking to people.

On March 24, she felt nausea and stomach pain. She thought her acid reflux was acting up: no big deal.

As she grew sicker, her doctor daughter grew more alarmed. Silky Singh Pahlajani, a neurologist, lives in New York City, where COVID-19 was overwhelming hospitals. Silky, 38, didn’t feel sure that her mom’s problem was COVID-19 — gastrointestinal distress was only beginning to be recognized as a symptom — but whatever it was, Silky felt sure it was serious. On the phone, she urged her mom to see a doctor.

Rita resisted. This was one of her regular tiffs with Silky: Other than basics such as annual checkups, the doctor’s mother avoided doctors. She preferred home remedies. And so far, that had worked fine: Rita was healthy and full of energy. In the 30-plus years she’d lived in the U.S., she’d never been hospitalized.

She made it clear to her family that she didn’t intend to change, either. If she were ever severely ill, she’d told them, she didn’t want extreme measures taken to save her life. “She thinks she’s immortal,” Silky grumbled.

But this time, Rita’s home remedies weren’t enough. After a few days she was so fatigued that she couldn’t stand. She submitted to a virtual doctor’s visit, and was commanded to go to an ER immediately for hydration.

She was rolled into a small west Houston hospital in a wheelchair. Then she blacked out.

Silky went into hyperdrive, constantly trying to talk with the doctors treating her mom. Furious that the small hospital was waiting for test results before treating her mom for COVID-19, Silky insisted Rita be transferred by ambulance to Houston Methodist in the Texas Medical Center. Being at the bigger hospital, Silky thinks, saved her mother’s life.

Rita’s lungs were failing fast. A pulmonologist told Silky he’d never before seen a chest X-ray go completely white in 48 hours.

Silky knew that a ventilator was precisely the kind of extreme measure that her mother wouldn’t want. And as a doctor, she knew why ventilators are any doctor’s last resort. They leave a patient vulnerable to infection, lung damage and delirium. Many patients put on ventilators don’t survive, and the longer they’re on ventilators, the worse their chances. As a neurologist, Silky had seen the brain damage and strokes that a ventilator can cause — exactly the kind of impairment that her strong-willed mother would hate most.

But Silky couldn’t let her mother die. Roughly 24 hours after Rita blacked out, she was intubated for a ventilator.

The family, not allowed to visit Rita in the COVID ICU, talked to her unconscious body via an iPad. They hoped she heard them somehow.

The weeks crawled by. Rita’s lungs improved, but COVID-19, Silky says, “is like a hurricane that blows through your body.” Complication after complication arose. Rita’s blood pressure dropped. Her liver was damaged. Her kidneys began failing, and she needed dialysis.

Silky consulted frequently with Rita’s medical team, which she considered top-notch. And as different problems arose, Silky called almost every specialist she knew — friends from residency, from her various trainings, anyone she could think of — to pick their brains.

At one point, during the weeks when Rita should have regained consciousness but didn’t, it seemed that she might have had a massive stroke — the kind of problem that Silky herself treats. But an MRI showed no blood clot.

Still, as the days ground on, Rita’s prospects grew dimmer. By April, the family was bracing themselves: There was an 80 to 90 percent chance that Rita would die.

“Encephalopathy” is doctor-speak for “some kind of problem with the brain.” To treat it, Rita’s medical team tried steroids.

After the first dose, she opened her eyes. She wasn’t responsive, but the family was thrilled. “We’ll take it!” Silky said.

Rita improved. And at the end of April, she woke up.

She remembers opening her eyes, not knowing where she was, and hearing a doctor she’d never seen before tell her that she was at Methodist Hospital. She didn’t understand what had happened. Her body was stuck full of tubes. She was in pain and confused.

She planned to escape when the nurses weren’t in the room. From her bed, she considered various routes: the window, the hallway. But when she at last got her chance, she found that she couldn’t move her hand to rip out the tubes. In fact, she couldn’t move at all. She couldn’t even call for help: Her voice was gone.

Where, she wondered, was her family?

Slowly she began to understand the nightmare she’d woken into. And at last her family members, thrilled, began to appear to her on the iPad. Rita beamed at her husband. And she beamed, too, at Silky’s sister, now seven weeks more pregnant than she’d been when Rita blacked out.

But Rita glared at her doctor daughter. It was Silky’s fault, she thought, that she was here in this condition. Silky knew that she’d have preferred to die.

But there she was, alive. In their video visits, to keep her spirits up, the family dangled the prospect of her first grandchild’s birth. She wanted to see that, didn’t she?

On June 17, after an awful seven weeks on a ventilator, Rita was at last able to leave the hospital. The sunlight was beautiful. In the car she opened the window to feel the wind, to hear the birds.

The next day Silky’s sister gave birth to a girl. In a photo taken a few weeks later, on the first day that Rita was strong enough to hold the baby, the new grandmother is beaming.

With therapy she’s getting stronger, Rita says now. She’s anxious to return to work.

And she has forgiven Silky for keeping her alive. In fact, she’s now grateful for the extreme measures. She tells Silky, “You are my angel.” And she warns her doctor daughter, sternly, to be careful not to catch COVID. — Houston Chronicle