I am sorry

A year ago today, my four siblings and I had to decide whether our stepmother should have to share her birthday with the anniversary of our older sister’s death. I argued that we could not do that to our stepmother; we should wait one more day. She didn’t mind. She wanted what was best for Philomena. After 7 days on a ventilator, feet and legs swollen, lungs muddied by pneumonia, it was Philomena’s time.

Here we are today, one year later, and I can’t bring myself to send birthday greetings to my stepmother. For one year, I couldn’t bring myself to write in this blog, her eulogy being my last post. A 2020 death almost certainly means that someone died of COVID. When friends or colleagues inquire about Philomena, I tell them she didn’t die of COVID, she died because of COVID.

For 10 years, our mentally and physically handicapped sister lived in a nursing home. When our father fell down a flight of stairs and shattered his pelvis, at 70 years old, it was no longer possible for him to care for Philomena. She resided in a facility a few miles from his house where he and my stepmother could visit her weekly after Sunday mass. The siblings and I visited Philomena when we came into town to visit our parents. With each visit, Philomena would let us know how she was doing, but in a manner of speech that only parents and siblings could understand. In other words, she had the mental capacity and language skills of a toddler. At the hospital, Philomena could not advocate for herself, nor could she convey to doctors or nurses that she was suffering. Several years prior at the nursing facility, her right femur snapped during a diaper change. The nurse heard a pop and felt her white porcelain skin untouched by the sun, hang loose from the knee joint. The emergency room doctor suggested that we leave the snapped femur alone because “she couldn’t walk anyways,” bound to a wheelchair for decades. In that moment, I boiled with rage that failed to form into words of disgust at the thought of leaving a defenseless handicapped person in pain. Instead, he got my choked tears. I was angry at his ignorance and lack of empathy, but possibly more angry at my father who insisted with white knuckled fists that Philomena stay at the nursing facility because it was covered by Medicare. To move her to a smaller facility where she could have received more personalized care would have opened his wallet wide.

What was his American Dream for? He came to this country with my mother in 1965 and risked it all to build a dairy farm and future for his 6 kids. The American Dream even took the life of my mother in 97 who sacrificed everything for the dairy business, her husband, her kids, her Philomena. Cancer is a Bitch is an understatement. Forgetting the lessons of losing someone to cancer is life. We forget. My father forgot. He lived his life, repeating the same mistakes he made with my mother with his second wife, putting money before love, pride before paternity.

Doctors pieced together Philomena’s femur with two screws visible beneath her translucent skin. Doctors diagnosed her with severe osteoporosis and prescribed calcium and Vitamin D in order to slow down the bone decay. In January 2020, one week before my father’s funeral, Philomena’s bone snapped again, but this time it was her right foot. Nurses claimed that they just found her foot broken. “Your bone doesn’t just break!” I snapped on the phone with my younger sister. “I know, I know. I’ll handle this,” she replied. Once again, Philomena was put back together like a lego piece, but there was no investigation of what happened at the facility. How long did she have to suffer with a broken foot?

Two months later, the world stopped for COVID.

The nursing facility had strict COVID regulations: no visitors permitted inside the facility. And so it went, month after month, 6 long months of Philomena living alone in a gray-walled room sharing the light of a muted television with a Mexican abuela, shouting Spanish profanity in her delirium. Philomena had no awareness of spiked viruses, global pandemics, or COVID protocols. She didn’t know why we did not come to visit. The answers to why, a higher order cognitive response, exist in a fully developed frontal cortex. The part of the brain that feels our absence, that searches the room for familiar smiles, is the amygdala. Without our physical presence, our touch, sounds, smells, and laughter, she is alone in that unlit corner of the brain.

On September 7th, we finally had our chance to visit Philomena. She lay on the hospital gurney, her crippled legs and arms motionless like a dead daddy long-leg. The ventilator tube siphoned the fecal matter that entered her lungs. Hours earlier, in a late-night voicemail, the nursing facility alerted my younger sister that Philomena had not had a bowel movement in 72 hours and had been rushed to the emergency room in cardiac arrest. According to the nursing facility’s protocol, medical experts are notified at the 72-hour mark when a patient has not had a bowel movement. It is not clear when exactly her bowels ruptured, spilling fecal matter into her lungs. It is not clear when she stopped breathing and needed to be resuscitated. It is not clear how long she listened to the unmuted cries of a mad woman while drowning in her own fecal matter. Once again, no investigation was conducted regarding the possible neglect of my sister. Are they to blame for her premature death? Possibly. The facility already had a COVID death two months prior. Another patient died alone. His wife would take the long bus ride each day to visit him at the nursing facility. Once the COVID protocols were in place, no amount of pleas and tears made a difference. He died months later in the company of her absence. I want to blame the nursing facility, but then I understand that the additional protocols in place to protect vulnerable patients exhausted an already exhausted underpaid staff. An investigation would only expose us to an underfunded health care system and neglected population, which we have already known for years. I want to blame the millions who should have worn their fucking masks and kept their distance, which left nursing homes defenseless and under constant threat for months. How many families joined in the delirium of grief, crying outside the closed doors of nursing homes, hospitals, and graveyards? I want to blame my father and the learned helplessness and fear that reside in the amygdala, the size of a pebble, but the power of stone walls. I blame myself for not advocating for my sister sooner. After my father’s death and the growing peak of COVID cases, we could have finally removed her from that facility and provide her with the care she deserved.

Choked by tears of silence, after one year, I write again, today, for my sister, “I’m sorry I did not speak when you needed me to speak on your behalf.”