The third Friday in April 2021 started like that. I had a late start at work (9am) and as it was a Friday, a half day. I'd be finished by 12. I'd been working in a local nursery since the middle of March, an emergency lockdown job after the consulting I'd been doing for most of 2020 had ended abruptly, one of the many lockdown casualties. Friday was a chilled day, no children in. We'd get all our planning and admin done, plus a staff meeting to start the day.
As I gathered my things before leaving home, I checked my phone for any important messages or updates. Only one from my brother Junade, sent late on Thursday night to say that he'd found Abbi (our dad) in a semi-conscious state. Nothing out of the ordinary then. We'd had so many years of Abbi being like this, passing out, fainting, losing consciousness for a few minutes that being in a semi-conscious state was nothing to be concerned about. He did have a UTI but as he struggled to take medication in pill form now, we were waiting for him to get it in liquid form.
At work, we started the staff meeting with a discussion of what we had planned for the weekend. We'd started coming out of lockdown at the start of the week, high streets were starting to reopen. We could move around again, make trips a little bit further afield, start making plans. The weather forecast was good for the weekend and I thought about a spontaneous trip down to Brighton to enjoy the sea air and catch up with friends. After months of not going more than a couple of miles away from home, a little road trip felt like the greatest adventure.
During the meeting, I was aware that my phone had been pinging with notifications so I checked it as soon as I could. My younger sister Alia had sent a message asking how Abbi was. Abbi's private carer S had responded to say that he was still fast asleep and that the paramedics had left. Junade had called the paramedics when the morning care team had been unable to wake Abbi. He had a double-handed care team (two people) come three times a day to look after his personal care needs and to move him. Following on from a major stroke in September 2019, Abbi had been left unable to sit, stand or walk unaided and ever since returning home at the end of October 2019 as an 'end of life' patient, he'd spent his days and nights in one room, moved from bed to a chair and then back to a bed again. He had been forced into a life inside a room even before the pandemic had started.
Abbi was still in what seemed like a very deep sleep by the time I finished work at midday. I went straight over to check up on him and see if I could rouse him. He'd been found in a similar unresponsive state a few months earlier and once again paramedics called. No one had been able to rouse him but as soon as he'd heard my voice, he'd come round. When I got there, I called his name a few times but nothing. I shook his shoulder gently, then a little harder, but still nothing. He was sat up in his hospital-issue bed, supported by pillows, fast asleep. He looked perfectly happy and had a golden glow to him. There appeared little I could do, Abbi didn't seem to be in pain or distressed so I left again to run a few errands.
As I drove along the high streets, seeing them open up again filled me with a giddiness of excitement and joy. I'd been at work all week, so I'd not yet seen any 'non-essential shops or businesses' open. I felt like those cows who have been cooped up inside all winter when they're let out into a field again and they run around, kicking their hooves up in excitement! Finally, it felt like life was returning to some kind of normal again and we perhaps wouldn't have to face another lockdown?
Errands completed, I made an impromptu visit to my best friend C. While aspects of life were starting to open up again, we still weren't allowed to be indoors with anyone who wasn't in our 'bubble' so this would either be a doorstep visit or a garden visit. As soon as I arrived, I went straight into the garden where C and I sat, far apart, catching up. We hadn't seen each other for months so we spent a few hours basking in the sunshine, sharing all the ups and downs of our respective lives. What a strange time we were in, had been in for over a year now. A time where my best friend couldn't hug me, even though we'd both had our first doses of the vaccine. Lockdown or no lockdown, the one thing that hadn't changed was our ability to talk about anything and everything, from the deepest, most personal topics, followed by something that would have us both creased up in laughter!
As we chatted, my phone pinged away with notifications. I carried on the conversation with C but as soon as there was a break, I checked up on the messages. Abbi was still in an unresponsive state. A doctor from the local surgery had been to check up on him and give an update. Abbi's UTI infection was in a progressive state and he needed antibiotics but these could only be given now as IV antibiotics due to his unresponsive state. He was comfortable, didn't need morphine and we'd been told to keep him comfortable. He may have had a seizure but without hospital intervention, we had no way of knowing what exactly was going on with him. As he was unable to eat or drink anything, Alia was asking if there was any way of getting a drip for him for nutrition? The messages were taking on a more frantic tone and it became clear that the only course of action, if we were to do anything more than keep Abbi comfortable, would involve Abbi going into hospital and here lay the problem. When Abbi had come out of hospital in October 2019, he was not expected to ever go back again. He was considered an end-of-life patient, wasn't expected to live more than a few weeks or months and as his firm wish was to spend his final time at home, we were to keep him at home and manage any health issues with the support of his GP's surgery, district nurses and St Christopher's Hospice.
Add to this the layers of complexity due to Covid. When we'd first gone into lockdown in March 2020, none of us could visit him. Even with the government telling us what we could and couldn't do, we were petrified of catching the virus and passing it on to him. Abbi was already in such a frail state that if he caught Covid, would he survive? We'd had a conversation in the early months of lockdown, to try and decide what we'd do if his health did decline. Alia was adamant that he would need to go into hospital, the rest of us against it. Not because we didn't want him to have treatment but because if he went into hospital, would he ever come out? Was he more likely to catch Covid? Would we see him again? Could we risk him dying alone in hospital?
In the space of a few hours, everything had gotten very serious. I updated C on what was going on and headed back to Dulwich. Abbi was still unresponsive and advice from both the GP and St Christopher's was to keep him comfortable at home. But should we take him into hospital which was the only place he could get IV antibiotics to treat his UTI? We had an emergency siblings video chat to try and decide what to do. Junade and I were both in Dulwich, Alia and Rahila in their respective homes. We came off the call still undecided. Alia called our cousin Z, a doctor, who advised getting Abbi into hospital immediately. He needed IV antibiotics and IV fluids and the only place he'd get those would be in hospital. Two daughters and four grandchildren were on their way to Dulwich but the decision was made that Abbi needed to go to hospital immediately, not wait until the rest of the family were gathered. Decision made but how do we get him there? We were actually asking that on our sibling WhatsApp chat - we couldn't put him in a car and drive him there so what do you do?
In the end, I called 999 and the paramedics were there within minutes. An ambulance would be the only way we could get Abbi into hospital but even then, there were still so many risks involved. The team of paramedics were kind and patient but broke the news to me that if they did take Abbi in, there was a chance that he wouldn't survive the next few hours, that he would die before they were able to run all the tests before they could give him IV antibiotics. What? How did it get to 'this'? I couldn't process what I'd been told, it all seemed so sudden. The day had started so normally, how could it have turned so dramatically?
Even though his records said that he was not to be brought into hospital, they would take him in if that's what our wishes were. But still, what do we do? I felt the weight of the decision on me. As my sisters were on their way to Dulwich, I had to decide what came next and also face the consequences. If we took Abbi in, there would be a strong chance that he would die in hospital, something I knew he did not want. We might not be able to visit him, he might die alone. But a decision had to be made and I couldn't lose any more time with such a rapidly moving situation. I asked the paramedics three questions in the event I did say yes to Abbi going to hospital.
1) If it looked like Abbi had a matter of hours to live once admitted to King's, would his children and grandchildren who were all en-route to Dulwich be able to come and see him? His four eldest grandchildren hadn't seen him for over a year and it was critical that his family could see him in hospital if he had hours to live.
2) If Abbi was in hospital, would we be able to visit him? With the ever shifting sands of lockdown rules and regulations, we weren't sure if he'd be allowed visitors and we needed to be able to see him. He would need to have his family around him otherwise he really would lose the will to live.
3) If there was little that the hospital could do for Abbi, could we bring him back home again? While Abbi might not have been aware where he was in his unresponsive state, I knew he did not want to die in hospital and we'd have to be able to get him home again so he could pass his final days and hours in place that had been his home since before I'd been born.
I got a 'yes' for all three questions and with that came the decision to take Abbi to King's. The paramedics got Abbi ready to move into the ambulance, bringing him out of the room he'd lived in for over 18 months. Before they took him out of the house, Junade's two children, Abbi's youngest grandchildren, came down to see him and say goodbye, just in case he didn't make it home again. We didn't tell them the enormity of that greeting but it was important that they saw him before he went into hospital.
I accompanied Abbi in the ambulance. Before I left the house, I grabbed a phone charger and a random pair of glasses as I had neither in my bag. Once at the hospital, I was guided into a family room and asked to wait until they had an update for me. Hours went by, I waited patiently, comforted by the sounds of Elbow's 'Seldom Seen Kid'. Eventually, just before midnight, a nurse came to tell me that they'd given Abbi IV antibiotics and he was a little responsive now. They were going to keep him in for the night and were waiting on a bed. I was allowed to go into his cubicle and wait with him. As I called his name, he finally turned his head towards me. This was a great sign but he was still in a vulnerable state. Keeping him in the hospital was the best thing but what if he declined in the night? Rahila, Alia and their children were all in Dulwich, waiting for an update from me. I ventured out of the cubicle and looked for a friendly nurse. I needed to get permission for my sisters and their children to come and see Abbi before he got taken away onto a ward, just in case anything happened in the night. I didn't know if this would be allowed but I had to ask. It was a yes and within minutes, the rest of the family was there. He could still only have one person with him in the cubicle so everyone waited in the family room and one by one, came out to see Abbi. We were probably a bit of a nuisance for the A&E team but they graciously allowed us to spend a little bit of time with him before we headed back to Dulwich.
I eventually got back home just after 2am and tumbled into bed, knowing that all plans to visit Brighton that weekend would have to be suspended.
