The family — including me, from a distance — had been trying for several days to manage my uncle’s care at his home in Hyderabad. He suffered from obesity and diabetes, both conditions that predispose patients to negative outcomes, but with hospitals near him overcrowded, he preferred to try to push through at his house. When he first became ill, I told my cousin to go to the neighborhood pharmacy and buy oral steroids. I advised him on the correct dosages to start if my uncle’s oxygen levels dipped, and my uncle soon needed that treatment. For several days, my cousin and I texted back and forth or spoke on the phone as my uncle’s health deteriorated. I suggested placing him on his stomach — doctors call this “proning” — to improve his oxygen intake.
It complicated matters that two other people in the house also were infected — my cousin and my aunt — although their cases were less severe. My cousin was nonetheless exhausted, and my aunt continues to cough even now, weeks later.
The situation I found myself in is not an unusual one for first-generation immigrants to the United States from India: We are trying desperately to keep our loved ones alive, from afar. And we are doing this even as our own jobs in the United States give us no respite. We are still working and meeting deadlines (and sometimes missing them) while taking on these extra duties.
Many of us have lost family members: Another relative of mine in northern India — the father of a cousin’s husband — died just days ago after a weeks-long battle in an intensive care unit.
The millions of low-income Indians are experiencing the worst of the pandemic, but this crisis is society-wide. As one of my cousins put it bluntly, even with connections, many Indians are unable to get basic care. My grand-aunt, a renowned and now-retired gynecologist in Hyderabad, was barely able to get a bed at her former hospital when she became ill. Thankfully, she improved there and is doing well. But most people without that degree of social standing are either shut out of the system — or face ugly surprises. One of my father’s best friends got sick before the peak of the surge; he spent weeks in an ICU, only to be told at the end of the stay that he owed a sum far beyond what he had expected. He eventually recruited a local television station to cover this exploitative situation, and his bill was whittled down to a fairer amount.
Not long after the oximeter false alarm, my uncle’s oxygen levels began hovering in the lower 90s — the range at which we typically start oxygen for patients in U.S. hospitals. My cousin managed to obtain a consumer-grade oxygen concentrator through a family friend who had procured a batch. To make the limited oxygen supply last, we tried to keep his saturation levels hovering at the borderline level of 92 percent.
When it dipped into the 80s, however, we increased the flow — and decided it was time to get him a hospital bed, if we could find one. We hit several dead ends before landing a spot through a former medical school classmate of my mother’s. Unfortunately, it was in a private hospital that asked for payment up front (which would leave my cousin to deal with insurance later). In the middle of the night, administrators were asking our family for more money than we had readily available. Through more phone calls, we were able to get the rate lowered. He was admitted to the ICU for several days before transitioning to a regular floor and is now safely back home. Without the access to oxygen and steroids that he’d had at his house, and without a family that could pay for private care, the outcome might have been far less fortunate.
As a clinician, I have treated hundreds of coronavirus patients in America, mostly in Boston, over the course of this year, in well-equipped hospitals. And over the past several years, I have spent time caring for patients in rural parts of India, Africa and Central America, where access to care is minimal. But I did not expect these two experiences to come crashing together like this.
While we in the United States are celebrating the vaccination of teenagers, my family members are trying to survive this surge in India — and, of course, they are among the privileged in that population. Poorer urban residents and rural citizens are being decimated.
As a physician who specializes in global health, I’m thinking about the countries that may be next, after India. Most sub-Saharan African countries, for example, lack the ICU resources necessary to manage severe cases. Rampant variants combined with global travel put these largely unvaccinated countries at high risk of spread. Consider that three years ago, when I cared for patients in a rural hospital in Rwanda, we had almost no oxygen support, let alone ventilators. What would happen there if the coronavirus were to surge? Thoughts like that remind me how important it is that the United States redouble its efforts to vaccinate people in low-income countries.
I still text regularly with a friend who lives near the Rwandan hospital where I worked. The conversations are tense, but so far I haven’t had to give advice about how to keep people who are having trouble breathing alive for one more day. I pray that it stays that way.