“Have you ever been on a cruise?” Betty asks.

It’s a strange question in the age of COVID-19, where thousands of people have been stranded on large ships over the past few months. I’m a wound physician who rounds at nursing homes, and my gloved hand holds her warm, wrinkled foot. I’m looking at a wound on her ankle that is almost healed.

“I went on a cruise before, but it was a long time ago.” I try to speak loudly through my N95 mask.

Betty goes on. “Well, this is my first cruise, and I just love it,” she says, shaking her gray frizzled curls about her shoulders. I look up at her and smile. I’m in the memory care unit.

Since COVID hit, I’ve noticed that memory care is impossible in the pandemic. There are people who wander due to their Alzheimer’s disease. They silently pace along the wall in a loop around the unit, or into an opening that is sometimes the doorway to another resident’s room. I often find one woman who drifts through the hallways roaming into the nurse manager’s office. This woman lovingly gives the resident some conversation, leaving the emails she was answering.

I enter a memory care unit, and one of the nurses informs me that the resident I’m there to see is isolated and on droplet precautions for being exposed to a home health nurse with COVID. I must wear full PPE. As I head toward the woman’s room, I instead find her in the hallway with other residents.

“We do our best,” says the closest staff member, and they do.

As I usher this woman back to her room, I introduce myself because she never remembers me, even though I’ve seen her every week for three months for a venous wound. She loses track of what we’re doing in the middle of the wound treatment, and at every visit, she says, “the old gray mare ain’t what she used to be.” She can’t remember to stay in her room.

Some of the residents don’t know what time of day it is. Some won’t eat a meal without a staff person, encouraging them to take bites. You can’t keep the residents of memory care together, and you can’t separate them. They take off their masks minutes after a staff person puts them on.

I come into a large facility one morning, and a nurse manager says, “we have COVID on memory care. Your patient, Betty, is negative, but we’re still waiting on the test results for some of the other residents.” Without giving away personal information, she tells me it is one of the wanderers who fell ill and tested positive. The nurse managers sit mute. There is no laughter bouncing around the room; no funny story told from someone’s weekend before we start on wound rounds. I feel the quiet gravity in my core. The wanderer has likely exposed the whole unit.

“The families are calling,” the nurse manager says. “They’re crying. They haven’t seen their parents in two months, and they can’t see them now. If they aren’t ill, some of them want to bring their parent home, but they aren’t able to care for them at home.” We find out later that a staff person was the source. I don’t know this person’s story, but Minnesota was sheltering in place at the time.

I come for rounds one week later, and it’s somber on all the units at this facility because of the tragedy in the memory care unit. The first person who got sick is dead, as is another. Two residents went to the hospital. A different unit has been converted to a COVID unit, and people are fighting for their lives there. These residents have care plans carefully and lovingly written by themselves and their families, choosing at this stage of life to never go to the hospital again.  A few sit confused and asymptomatic in isolation rooms.

A surprising number of staff quit coming in to work once COVID hits. I don’t know why this surprises me. There is staff who live with an aged parent at home, are pregnant, are over sixty-five themselves, or are just plain scared. I guess it’s such a sharp contrast to the dedication of those who still come to work each day. Those who are left often work double shifts. Nurse managers work long hours and sometimes stay into the evening to work as a floor nurse, or a nurse’s aide, because they are severely short-staffed. My heart warms as the head of building maintenance walks by me with a lunch tray he is delivering to a resident’s room. Everyone who is here does what is needed to provide the best care.

Two weeks later, two and a half weeks after the outbreak, there are four residents left in memory care. There used to be twenty. The weight of all this death, the weight of the grief of all the families, the weight of their own heartbreak over the loss of these residents they loved slumps the shoulders of the staff, as they continue to put one foot in front of the other to care for those who are left.

Betty smiles and tosses her gray curls as I hold her foot once more, blissfully unaware of what has happened. “The staff here are so nice,” she confides. “They help me with everything. And who would have thought that a doctor could see me on the cruise!”

This is what happens when COVID hits memory care.

Heather Awad is a wound care physician.

Image credit: Shutterstock.com