By Moira Wyton, Local Journalism Initiative Reporter, The Tyee
When Robert Billyard asked a doctor for a beer just before 9 a.m., no one in his hospital room was shocked. They were too relieved.
It was the first coherent sentence the 77-year-old had spoken since being placed in an induced coma while his body fought COVID-19 for more than a month at Abbotsford Regional Hospital.*
“Robert, he would think nothing of wanting a beer at nine o’clock in the morning,” said his wife Jenn Glead, sitting on their covered patio overlooking the Fraser Valley from their perch in Mission. “And when the doctor told us this, Colleen [his daughter] and I just laughed our heads off because, this is dad, like this is Robert.”
Just the night before, Glead, 63 and Billyard’s wife of 11 years, had “read him the riot act” about the things they still had to do and the grandchildren they still needed to meet. Twins were born to Robert’s daughter in Denmark on April 22, and the couple was itching to travel there as soon as it was safe.
So when he mistook the hospital for a pub and a doctor for a bartender, it was music to her ears.
“And that was the road to recovery, was him asking for that beer and me giving him shit,” she said, smiling at Billyard across the table, her colourful beaded earrings dangling.
Since waking up, the tall and burly Billyard has relearned how to walk and how to feed himself. Working back up to his normal typing speed is the next challenge for the avid blogger and consumer of world news.
Despite these setbacks, Billyard beat the odds. More than 50 per cent of people in their 70s who had contracted COVID-19 in B.C. by June had been hospitalized — 30 per cent in critical care — and 12.5 per cent had died, double the average mortality rate in that period.
But his recovery is not necessarily a roadmap for future successes, nor an indicator of the fates of the 288 other people hospitalized in the Fraser Health region to date.
As teams of doctors, nurses and recovery therapists make decisions with new information every hour, an infected patient’s outcome is still, to a degree, a matter of chance.
Billyard was hospitalized early in the pandemic as doctors and health officials raced to understand the virus, find new treatments and support public health measures to limit the spread, said Fraser Health Authority chief medical health officer Dr. Elizabeth Brodkin.
“Things were changing very, very quickly — our understanding of the virus and how it was going to behave, the numbers of patients that we were expecting to see, how the virus was being transmitted, and what it was that we needed to do to keep staff and patients safe,” she said in an interview.
“That rapid changing of information means your response needs to change rapidly as well. And that sometimes can be very challenging for the people on the frontlines where it feels as if we’re changing what we do every single day and they have to adjust quickly.”
Billyard isn’t taking the hard work of his medical team — or his luck — for granted.
“I’ve always been amazed how your body can revitalize,” said Billyard. “Especially considering doctors are working almost completely from scratch to keep people alive.”
An early retirement
It was the crowded, teeming lunchroom that first made Billyard nervous about work in March.
He had worked for decades doing maintenance for a large logistics firm alongside a group of “young bucks” who, he said, often didn’t take the safety advice of seasoned colleagues seriously until they got hurt themselves.
He felt their attitude would extend to the virus. And that, along with crowded meal breaks despite an additional lunchroom, caused him to retire two months early and self-isolate at home. “I decided right there and then that I was going to get out, because we have a lot of face-to-face contact in the building,” he said.
Glead picked him up from work on March 18, his final day. She was still working at that point too, making fudge at the nearby Cabela’s sport and hunting emporium, and they carpooled home before they began to isolate together. She soon took sick leave for fear of getting ill, then was temporarily laid off.
But by early April, Billyard’s behaviour had become erratic. He talked about booking hotel rooms for trips the couple would never take and called the fireplace repair company for fixes that had been kicked down the road for months.
He didn’t have the telltale COVID-19 fever. But a sore throat and fatigue worsened, with chills wracking his body as he announced his plans to make reservations at the Best Western in town.
“It was hard to tell because, here was this guy who was 76-years-old, who’d worked full time forever,” said Glead. “And so, I didn’t know how much of it was emotional, and how sick he really was.”
But she certainly wasn’t going to check into a hotel anytime soon. “I said to him, the only place I would take him was to the clinic or the emergency room.”
Glead called to cancel the fireplace repair appointment and drove him to Mission Memorial Hospital with what they thought was going to be pneumonia on Saturday, April 4.
“And then when [the hospital] looked at the lung X-ray, the doctor said the lungs are really bad,” said Glead. “At that point, they came and got Robert and he walked away.
“There were no goodbyes, there was no ‘See you tomorrow.’ There was nothing, and then he was gone.”
She was sent home to isolate and await Billyard’s COVID-19 test while he was transferred to Abbotsford Regional Hospital’s ICU unit. The couple spoke Sunday morning about this and that and said, “I love you,” expecting Billyard to be home in a matter of days.
By Monday morning, doctors had placed him in an induced coma to ensure his body would not fight the ventilator he needed to keep breathing. “The rest of the month is a blank for me,” said Billyard.
Glead spent hours on Zoom with Billyard and his medical team. His daughter linked in from Denmark every morning for the hospital’s daily updates.
The doctors were dealing with other critical patients, so Glead would sit for hours waiting for the social worker or nurse to turn on the feed when doctors got to Billyard’s bedside on morning rounds.
“He was wired everywhere,” she recalls. Meanwhile, she was assumed positive by affiliation, but didn’t suffer any symptoms except for a prolonged sinus headache. Never tested because she was never seriously ill, public health authorities now consider Glead one of the nearly 4,000 cases in the province because of her close contact to Billyard, also known as an epi-linked case.
Glead passed the time gardening — “it was my sanity,” she said — and an affirming thicket of blooming flowers surrounds the couple’s home. She watched Netflix, read and did puzzles her sister-in-law dropped off. One, a composition of Kellogg’s cornflake packaging through the ages, had a piece missing. It nagged at Glead, that she could have vacuumed up the final piece, or the cat, Boston, could have hidden it somewhere. “I hate losing things, even if it’s not your fault.”
And Glead, who had been glued to provincial health officer Dr. Bonnie Henry’s daily updates on the course of the virus, had to turn them off and get the news through friends after a couple of weeks. She couldn’t bear thinking that one day her husband would be one of the statistics rattled off in the briefing, or of the families — now 195 — living with the reality that their personal tragedies had been broadcast to the entire province, a number on the screen.
Life in a coma
Life wasn’t peaceful for Billyard either.
“For a month, I basically had a dream life,” he said. There were bank heists and drug busts, excessive drinking and stumbling around looking for the way home that he never found. “I had some very vivid dreams.”
But while his mind was active, his helplessness took a toll. “When you’re in a coma like that, you have a real sense of abandonment, you realize you’re in a complete vegetative state where you can’t speak and you’re not heard, and you’re at everyone else’s mercy and can’t do anything for yourself.”
Depending on the length and depth of a coma — and the types of sedatives used — they can be anything but a restful sleep, according to Dr. Srinivas Murthy, an expert in critical care and infectious diseases in the University of British Columbia faculty of medicine.
“Oftentimes things like delirium, anxiety and agitation can come up, because it’s obviously a very disconcerting scenario, being hooked up to a machine, only being partially awake and only being partially able to move,” he said. This is often a result of both the medications used and the disease itself.
Particularly for respiratory diseases, inducing comas can help a person’s body rest during their treatment. But the risks of ending a coma — permanent brain damage, or never waking at all — remain.
At the end of April, doctors began the gradual process of ending Billyard’s coma, a process which usually takes about five days as the drugs leave a patient’s system.
“And the week went by and he still really wasn’t waking up,” said Glead. “They were getting really concerned because he wasn’t getting worse, but he wasn’t coming out of the coma state that they put him in.
“He was just stalled.”
Glead and her husband had spoken about his wish not to end up in a long-term care facility, and doctors were not confident he would come out of his coma without a massive heart attack that could give him permanent brain damage.
On April 28, a week after he was supposed to be awake to meet his new grandchildren, Glead signed a “do not resuscitate” order, preventing lifesaving intervention should his heart or lungs stop. “It was the loneliest moment of my life.
“I was so angry, I was so frustrated and alone,” said Glead. She had made the decision while looking down at her husband on a Zoom link. “So I just read him the riot act.”
She spoke of all the things they still had left to do, the trips they would take and the meals they would cook together. Billyard had agreed to start doing more of the cooking once he retired, and she was eager to see what he would come up with. His three daughters had children they wanted to see grow up. There were new kayak and hiking routes the two needed to scout out together.
“I don’t recall hearing it,” said Billyard with a laugh. “That’s the question, because April is just a blank.”
But the next day, he started to respond to hand squeezes, mumbling unintelligibly until his beer order a few days later.
And when he was more lucid within the week, the world was another puzzle.
“You’re confused for a couple of days and you’re mixing up illusion and reality,” Billyard said. “I had to sort out what happened in the dreams and what was reality.”
He remembered conversations with Glead or his doctors that they said never happened. “It’s a matter of putting the jigsaw puzzle together.”
Like the one Glead had struggled with while he was in hospital. He and his wife both had their own missing pieces.
This process is complicated by the unknown effects of COVID-19 on the brain, said Murthy.
“When you’ve been given a sizeable number of medications to keep you asleep for a long period of time, your body adjusts to that,” he said. Doctors have to bring patients out of an induced coma carefully and gradually, so they don’t experience withdrawal or experience ill effects from the different medications.
“But sometimes it can be a rocky course… depending on how sick a patient was,” Murthy said.
There was another complication. The Abbotsford hospital had a COVID-19 outbreak and visitors were barred. Glead was kept outside its doors as Billyard recovered and made sense of his new reality. He was transferred back to Mission hospital on May 20, a week after leaving ICU.
Billyard estimates he was tested more than a dozen times for COVID-19, as he needed three negative tests in a row to be allowed to leave quarantine for his physical therapies.
“Even when I arrived in Mission, I couldn’t do anything with my hands, and they had to feed me for the first few days,” recalls Billyard.
Glead was facing challenges too. Mission hospital was limiting visitors, and she had to be content with a series of distanced visits from outside the hospital. They would visit curbside, Billyard wheeled out by a nurse or hospital staff, Glead pulled up to the side of the entrance, standing next to her vehicle.
But Glead was eventually allowed inside to see her husband. She brought sushi from a place near their home, including Billyard’s favourite golden dragon roll. Burger King was next on the menu as he worked through his physiotherapy exercises, practising how to swallow, walk and go up stairs again.
“My legs were like rubber, your muscles just collapse,” Billyard said. Strong from decades of working with his hands, he lost about 40 pounds during his months in hospital and had to essentially “build all [his] muscles back from scratch.”
Murthy says that although the Lower Mainland has better than average outcomes for pandemic patients in critical care, the challenges of recovering from COVID-19 or a resulting long hospitalization receive too little attention.
“We always talk about how many patients have died from the disease, but there is likely going to be a long period of rehabilitation and hospital use and health needs that may not be appreciated by the crude numbers that are recorded in the news every day,” he said. “This is not something that’s going to be short term, and the burden of the illness will extend well past the acute hospitalization.
“That burden long-term is going to be very important as we wrestle with all of the impacts of this pandemic.”
Being alive again
On June 16 — the day before Mission Memorial Hospital announced its own virus outbreak — Billyard was able to come home. But the couple’s bungalow was not without its own challenges.
That first night he tripped on the stairs into their home, and Glead had to call a neighbour to help him to his feet. For a time, the only thing he could not do was lift himself up from the ground if he slipped.
But while further from hospital care, home was its own respite. “Being back in my own bed was like a goddamn revolution,” said Billyard.
Billyard is now recovering at home and eagerly awaiting a future trip to Denmark to visit his new granddaughters. He says he has a few lingering symptoms and is focused on building back his strength. He worked up to walking around the block many times every day — bringing a walker just in case, but more often using it as a chair on their covered porch overlooking the Fraser Valley on sunny days.
Now the walker is collecting dust. Billyard went for a five-kilometre walk. Then a second, and a third, in the same week.
And on cooler days he spends time in his “cave” office, as Glead calls it, reading up on politics and world affairs, commenting away and even considering restarting the political blog he ran a few years ago.
“But running a good blog is almost a full-time job, and I’ve only just retired,” Billyard says with a laugh, his brown eyes crinkled and full of life.
The pair are eager to start kayaking and hiking together, but it will have to wait until Billyard is strong enough to rescue himself again should he capsize or stumble. His camping shirt betrays his desire to head back into the wild, but he says the slower pace since he left hospital has had its perks too.
Glead went back to work in late July. But the month they had at home together “had actually been a really nice affirmation for us and made our relationship a lot deeper and [added] a lot more dimensions to it,” said Billyard.
“We’ve had a whole month to ourselves just being around the house enjoying the garden and just being alive again.”
The couple’s Norwegian elk hound, Elska, has been keeping the pack together, too. Deeply protective, she barked as a delivery driver dropped off a new garden hose for Glead during an interview on Glead’s first day back at work. And she still doesn’t let the couple stand more than a few dozen feet apart before she herds them together again.
Both agree that it’s surreal to walk through the world so deeply changed by a virus many don’t appear to be taking seriously.
“They’ll never know until they’ve lived the last four months like we have,” said Glead. They still don’t know where Billyard contracted the virus, or whether Glead brought it home from work. They talk lightly about an imaginary prison guard from the outbreak-ridden Mission Institution coughing on Billyard in the liquor store, a theory that serves to complete at least one piece of the unsolvable puzzle.
In the meantime, the couple has to act as though they could become infected again. Billyard is clear he’s not scared to be out and about, but he takes every precaution possible to avoid contact with others. Nearby family come to visit in the garden but stay two metres apart. Billyard and Glead do their shopping as infrequently as possible.
“When you come so close to dying and then come back, it’s transformative,” said Billyard. He is looking forward to being able to travel again to visit his new granddaughters in Denmark. A cruise may even be in the cards for the avid travellers — but he says the simpler things right now suit him just fine.
“I constantly hear of people dying in their 70s, so to come through it and survive,” Billyard trails off, sitting at the patio table where he had that first beer he asked for, and many since.
“I live my life with gratitude.”
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