Avoiding the loneliness of a coronavirus hospital death

Avoiding the loneliness of a coronavirus hospital death

Emanuela Marchese mourns over the coffin of her father, Carmelo. Suspecting he had contracted the coronavirus, Emanuela and her family decided Carmelo should avoid a lonely hospital death and remain at his home in northern Italy. (Gianluca Panella/SestiniReportage)
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When it came time for the conversation about whether Carmelo Marchese should go to the hospital, his daughter didn’t tell him about her fears — that he’d be taken away in an ambulance and never see his family again. She didn’t mention the images on the news, of black body bags piling up outside hospitals, nor the images in her mind, of her father in one of those bags.

She just told him what she thought was most necessary. That northern Italy’s hospitals were overloaded. That a 93-year-old, weakened already with fever, wouldn’t be prioritized. That his odds might be no worse at home.

“You would end up in who-knows-what tiny hospital room,” Emanuela Marchese, 59, remembers telling him.

TOP: A couple in Brescia, Italy, looks out their window as emergency medical technicians respond to a call at their neighbors’ home. (Gianluca Panella/SestiniReportage) ABOVE: A covid-19 patient in Brescia is taken to the hospital by emergency responders. (Gianluca Panella/SestiniReportage)

She looks back on that conversation as the closest thing to a decisive moment about how Carmelo Marchese would die — in his bedroom, next to an oxygen canister, his crying daughter and grandson steps away.

During the coronavirus pandemic, the world has officially recorded more than 130,000 deaths, many of them happening in intensive care wards sealed off to family members in one of the most chilling aspects of the virus. But an uncounted legion has died in a far different way: never making it to hospitals, or even trying to avoid them.

Some of those deaths are less lonely.

Yet in place of regretting goodbyes they weren’t able to share, family members may be left with the anguish of wondering whether they made the right choice.

“If I think of my dad right now, I honestly can imagine him a bit angry at me,” Emanuela said three weeks later, as she and her children cleared out her father’s apartment. “Everyone is telling me that I shouldn’t be feeling guilty, but inside of me I have a vision of papa. ‘You didn’t take me to the hospital. Why?’ I have this emotional inner worry that hasn’t been lifted.”

Carmelo at the shipyard in 1947 during his time in the Italian Navy. After Carmelo died, his family went through the old photos he kept in his apartment. (Family photo)
Carmelo, wife Bianca Postiglione and daughter Emanuela enjoy in 1962 a beach in his hometown of Gallipoli, where his family is planning to bury his body. (Family photo)
Carmelo with grandchildren Elisa, left, Stefano and Viviana. (Family photo)
TOP: Carmelo at the shipyard in 1947 during his time in the Italian Navy. After Carmelo died, his family went through the old photos he kept in his apartment. (Family photo) BOTTOM LEFT: Carmelo, wife Bianca Postiglione and daughter Emanuela enjoy in 1962 a beach in his hometown of Gallipoli, where his family is planning to bury his body. (Family photo) BOTTOM RIGHT: Carmelo with grandchildren Elisa, left, Stefano and Viviana. (Family photo)

Carmelo Marchese had been a fairly healthy 93-year-old. He had bad knees, bad hearing, but he lived on his own in the city of Brescia, less than a mile down the road from his only daughter. He cooked. He gardened. He used Facebook and WhatsApp.

As a 13-year-old, he survived a World War II attack. He carried out anti-smuggling missions as a postwar Navy sailor and later worked as a bureaucrat in Brescia’s city hall. Into his 80s and 90s, especially after he became a widower, he became chattier, needier of social interaction. If he went more than two days without seeing Emanuela, he’d text: “Well, can you at least send a photo?”

So when he developed a fever on March 21, her first thought was to be with him as much as she could. She said she was moving into his guest room. He protested only a bit.

Emanuela wasn’t sure her father had the coronavirus. But he exhibited symptoms and could have contracted it at the nursing home where he received treatment for his balky knees. The family doctor told her to behave as if Carmelo had it.

So she brought gloves and masks to his house, and wore them whenever she entered his room. She sanitized the bathroom and kitchen relentlessly. She bought an oxygen canister at the pharmacy and followed the doctor’s advice to use antibiotics and a medicine to treat fever. But they didn’t curb his sickness.

Within a few days, his fever had spiked above 103 degrees.

“Look, Dad, it’s not like last year,” Emanuela said. A year earlier, he’d contracted bacterial pneumonia. They’d taken him immediately to a hospital, where doctors and nurses were able to devote plenty of attention to him. He’d recovered fully.

In Brescia, an emergency responder helps a patient with covid-19. (Gianluca Panella/SestiniReportage)

But in March, the hospitals of northern Italy were at their breaking point. Doctors told of having to reserve ventilators for younger patients with the best chance of survival, while older patients were left to die alone.

“You do not realize what is out there in hospitals now,” Emanuela tried to emphasize.

Her father said he understood, but then brought it up again, mentioning how well he’d been cared for a year ago.

As Emanuela thought about what to do, as she talked with her three children, what she felt most of all was anger. Anger that the family had to even make a choice like this. Anger that the hospitals couldn’t care for everybody who required it. Anger that the rituals of dealing with the sick had been so overturned by what Emanuela called “this blasted virus.”

Her father mostly stayed in bed. He got up to change his dentures, use the bathroom and have breakfast. He weakened by the day. His hands started trembling. When he struggled to eat, Emanuela spoon-fed him, and though her father didn’t say anything about it, she thought she saw some mix of shame and gratitude in his eyes. She wondered: At the hospital, who would have cared for him?

Her eldest daughter, a nurse, came by twice a day to inject antibiotics. Otherwise, Emanuela was alone with her father, checking on him, talking to him if he had the energy. During the days, she sometimes wept quietly, talking out loud to photographs of her deceased mother. A night, she stayed in the guest room, not sleeping much, listening to her father inhale and exhale. By the sixth day of fever, his breathing had become more labored.

“Like he was running stairs and gasping,” Emanuela said.

Emergency responders and Stefano lift Carmelo. The responders administered CPR but were unable to revive him. (Gianluca Panella/SestiniReportage)

She called her son, Stefano, to come help. He, too, followed all the precautions he could, putting on a mask and gloves. He was the one who noticed the hallway light flick on around 2 a.m. on March 28. It was his grandfather, in the bathroom.

He’d gotten there somehow, but it had cost him all his strength.

Walking back down the hallway with Stefano and Emanuela’s help, his body gave out, like he’d fainted. They rushed him back to his bed, frightened about what to do. They shook him hard enough to revive him. They propped up his feet. They gave him some sugar water. Maybe the worst for the night was over, they thought.

But then Carmelo had a request: Could he return to the bathroom? He still needed to go.

“I didn’t want him to soil himself,” Stefano later wrote in a four-page personal remembrance of his grandfather’s last hour.

So, Stefano helped him to the bathroom again. This time, the walk down the hallway was even harder. This time, while Stefano was holding him, Carmelo’s knees buckled. Stefano couldn’t catch his grandfather before he fell to the floor. Stefano and Emanuela hauled him up, acting as quickly as they could, and got him back on his bed. But he said nothing. His eyes were rolling back.

Stefano, crying, called emergency operators and his sister Elisa, the nurse, to come as quickly as they could. Then he tried performing CPR.

Emanuela wailed again and again, “Papa.”

Carmelo's granddaughter Elisa arrives to join her grieving mother and brother. (Gianluca Panella/SestiniReportage)

When the medics arrived 15 minutes later, wearing face guards and blue protective suits, they put Carmelo’s body on the hard wooden bedroom floor and tried for several minutes to revive him. One of the medics leaned over him, pressing with dire force on his chest, and it was enough to make his upper body swell and deflate. But he was not breathing. When the medic stopped, Carmelo stopped moving as well.

Three weeks later, the home of Carmelo Marchese was half-empty. His daughter and two of his grandchildren were inside, all wearing masks. Day by day, they had cleaned off and boxed up the dishware, the clothing, the old photo slides, the operas on cassette, the VHS movies. A few pictures were still on the walls. Whenever Italy’s lockdown ended, somebody might be able to haul away the boxes.

Emanuela and daughter Viviana organize photos of Carmelo during his youth as they pack up his apartment. (Gianluca Panella/SestiniReportage)

Carmelo’s body was sent to a cemetery in Brescia, awaiting transport — eventually — to the southern city of Gallipoli, the place where he’d been born. Whenever that happened, he’d be buried next to his wife. The family imagined a ceremony where everybody would gather, where there’d be a Mass, a recitation of a Navy poem, where Stefano would say a prayer. But when might that happen? Months from now? Years?

“Once this plague is over,” Emanuela said.

She wondered if, by then, they’d be any better at making sense of his death, or even know if he’d died because of the virus. She wondered if, by then, she’d still imagine her father angry at her.

The younger of her two daughters, Viviana, 29, said keeping Carmelo at home had been the right thing for a 93-year-old, the only way to give him a “last caress.”

Elisa, with her husband and their daughter, mourns Carmelo's death. (Gianluca Panella/SestiniReportage)

Stefano, 28, said he was replaying his own decisions — about the CPR he’d tried and whether he should have done something differently.

Emanuela said that was how the human brain worked: concocting things, replaying things, even after it was too late.

She thought what she’d done was rational. She’d been there for him. She’d made his last days as comfortable as she could. Nobody else in her family had gotten sick in their time with him.

“But then I think of my father in the beyond,” she said. “It’s an unjustified guilt. I don’t know if it will go away.”

Edited by Marisa Bellack. Photo editing by Chloe Coleman. Video editing by Alexa Ard. Copy edited by Frances Moody. Design and development by Brandon Ferrill.

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