Corona and decision making trauma

I made it into Thailand and down to Koh Tao, a jewel of an island in the Gulf of Thailand. The 10 hour bus and ferry journey (complete with a bus accident) was forgotten the second I saw where I would be staying for at least the next two weeks.

“Wow, I’ve landed in paradise.”

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Paradise indeed

Everyone on the boat was immediately taken to a waiting area and told to download a health form and fill it in. For the next two weeks, our hotels would have to take our temperatures every day as well as ask us if we had any of a list of symptoms. Miss one day, and you are automatically be quarantined for 14 days.

There have been no cases on Koh Tao so far, and the local government is taking this seriously. Two days after I arrived, the Thai government declared a state of emergency and a fairly comprehensive lockdown of major urban areas. So far, apart from having to wear masks in public and maintain social distancing (enforced by restaurants and bars which are also closing at 8pm), life here has not been too affected.

On my first day here, I woke up with a slight cough and tingly throat. I told my hotel when they did my morning check up and they called the local health authorities. As a precaution, I was sent to the main hospital here, checked out in isolation (a chair on the verandah outside the hospital, away from everyone) and told that I probably just had a sore throat because of all the air conditioning on the bus and boat trip over. They gave me some medication (Thai herbs and vitamins and anti-cough medication) and told me to come back the next day. I haven’t had any fever and the cough is gone (haven’t used air con since!) so the doctors were happy to discharge me. I was impressed by how seriously they took the whole thing, I felt like a bit of an idiot for all of the fuss over a very slight cough, but then you can’t be too careful these days…

Throughout this, I was trying to decide whether to try and get back to Europe or risk staying in Thailand and getting trapped in a country whose health care system isn’t as advanced as those in Europe (though just look at what 10 years of austerity has done to the NHS). I found making the decision incredibly difficult, and felt a teenage resistance to the idea of returning to Europe. It took a while for me to understand why I felt this way, eventually realising that all of this felt very familiar.

When I was 5 months pregnant with Jamil and told there were complications, I had a 4 week period where I was faced with the decision of having a risky c-section and delivering an incredibly premature, growth restricted child (and subsequently going through at least 6 months of him in ICU) or letting nature take its course and having a stillbirth. The chances of Jamil being disabled in some way were high, according to my obstetrician. The neonatologists couldn’t say with any certainty whether he would be disabled, but could list all the potential disabilities he could develop- it was a long list. They couldn’t tell me the odds of any of the conditions developing, or the odds of him having severe vs mild forms of them. No one knew anything for certain, and apart from the awful consultant I saw once who, after pushing the ultrasound so hard on my belly I had bruises after, told me “well clearly your son is going to die. I’d give it a few days”, no doctor could tell me anything for sure.

I don’t blame any of the doctors (apart from the asshole who bruised me), they gave me excellent, amazing care, and quite rightly didn’t want to give me false hope or influence my decision in any way. I was left with a stark choice, an impossible and cruel decision to make. I discussed it over and over again with my family and close friends, I spoke to the doctors repeatedly, I spent hours and hours trawling through online forums, reading women’s accounts of their experience with this condition.

For the first 10 days after I was told there was a problem, I wasn’t told that I had a choice. Every doctor I saw assumed I wanted to have my son, no matter the consequences. I was told I would have to change hospitals again (I moved house when I was 4 months pregnant, so had changed hospitals) as I needed one with a neonatal ICU. I immediately realised I wanted to go back to my previous hospital (shout out to Homerton Hospital in Hackney. I cannot fault a single thing about my experience there, every person I interacted with, from the consultants and midwives down to the receptionists, were compassionate, kind and calm) but had to wait a week as they couldn’t schedule me for a scan before then. In the meantime I went to another large hospital, where the head of department bruised me and spoke to me about how Jamil was going to die without making eye contact or waiting for me to ask any questions before leaving the room.

By the time I saw my consultant at the Homerton, I was a mess. I was in a permanent state of anxiety, unable to sleep at the thought of the long road of ICU drama that lay ahead. He scanned me, took all the measurements, talking me calmly through each one. At the end, he let me sit up, and we discussed everything. He said the outcome didn’t look good, but he couldn’t say for sure. He explained every measurement to me, what they meant, and what the process of having a c-section would involve. And then he said: “You are faced with an awful choice, and I wish it wasn’t so. You can proceed with the C-section, and we’d need to schedule that for the next week, or you can decide that you no longer want to proceed with the pregnancy.”

I was taken aback. I had a choice? I explained that I definitely didn’t want to take any steps to end the pregnancy, I couldn’t do anything to actively end my child’s life. But he explained that I could wait for nature to take its course. He explained what would happen, how Jamil would pass and I would then be induced and have a stillbirth. He explained that it would probably happen in the next two weeks.

I will forever be grateful to that doctor. As much as I found the choice and decision torture, the fact that I had a choice was everything. In the end, after speaking to neonatal doctors, visiting the ICU and speaking to friends who had gone through premature birth (none of them with a child who was growth restricted though), I decided not to put him through it. Babies in intensive care are often in a lot of pain and are given morphine, which they can then get addicted to and have to go through withdrawal. They are subject to one painful procedure after the other (no one knows if the morphine is totally effective either) and even if they make it out of the ICU, they frequently have behavioural, cognitive and physical disabilities as a result of their time in ICU. This on top of any disability he’d have as a result of his being growth restricted. I would be a single mother bringing up a disabled child, an important factor too.

My gut, once it stopped being in a constant knot, told me what I had to do. I argued with it, I looked at everything from every angle, I allowed myself to have hope, but in the end I went with my gut. I love my child, I don’t want him to suffer even one tiny bit. If I had had him, he would have suffered. Either only for the first few months, but potentially for the rest of his life. His quality of life may have been atrocious and mine would also have suffered enormously. I might not have been able to look after him the way he deserved. The stress may have overwhelmed me completely.

I couldn’t do it to him. I couldn’t risk him suffering just so that I could have a living child. As my friend pointed out to me: “You’re already a mother Larissa and you will always be a mother, no matter what happens.” She was right. This might be the only parenting decision I would get to make, and I made the decision as a parent, not an individual.

I decided to wait it out. I was told to expect it to take two weeks. Jamil had other plans, and kept fighting for 6 weeks. He defied the doctors and took his time, stubborn like both his parents. Those 6 weeks were the most difficult and amazing ones of my life. I spent every day talking and talking and talking to Jamil, I tried to fit a life time of life lessons into the time we had left. I told him how much we loved him, how beautiful the world is, I made him listen to every kind of music I could think of (both me and his father are passionate about music, as he would have been too), I danced around my flat with him, I cooked lots of different foods and I cried, a lot. I also met up with his father, estranged as we were I knew he would want to say goodbye, and he was able to. Maybe that’s why he hung on, he knew I wasn’t ready to say goodbye to him yet.

After six weeks, I asked to be induced. I couldn’t take it any longer. Each day was a torture, counting his movements (less feisty each day), once going to hospital as I thought he had stopped moving-he started kicking me the second I lay down and had the trace put on my belly. On a Thursday, at my twice weekly scan, I asked to be induced, and they scheduled it for Monday to give my sister time to fly over from Greece. On Friday, Jamil’s father and I had dinner, and parted knowing it was the last time the three of us would be together. On Monday, an unusually warm and sunny day for February, I went into hospital and he was born shortly after midnight.

Writing all of this has been incredibly difficult, I’ve had to do it over a few days as it’s overwhelming reliving it. I didn’t realise how quickly I had erased all the ups and downs of those weeks. I had forgotten all the knowledge I gained too: it’s amazing how much you learn during these experiences. By the time Jamil was born, I knew what a Doppler scan was, what the symptoms of pre-eclampsia were, I knew all there is to know (as a lay person) about Inter Uterine Growth Restriction, NEC in premature babies, and how birth weight affects future life. All of this knowledge, gained in a time of extreme stress, was obliterated when I gave birth. The agonies of those weeks were pushed aside when I saw Jamil’s face.

But they have to come out somehow, trauma has a nasty habit of sticking around in your subconscious and reappearing whenever a situation mimicks that feeling. For me, it was the decision I had to make about coming back to the UK or staying in Thailand.

Again, neither option is without risk and difficulty and again, there is no certainty about anything apart from how difficult the situation is. I made pros and cons lists, and sat with my extreme anxiety around not being able to get back to Europe if something should happen to my mother or sister. I spent a lot of time thinking about my options should I return to Europe. Firstly, where would I go? I gave up my flat and my job, I have no home to speak of. The only place I could call home is my mother’s flat in Brussels, but going there would risk exposing my mother to the virus-which would probably kill her.

If I returned to London, I could possibly stay at my cousin’s flat-him and his husband decided to spend lockdown in Spain, but that would be dependent on my cousin being able to courier the keys to me. I would then be in London, alone in a flat, with no job (or income or possibility to apply for social security benefits as I left my last job) for the foreseeable future.

The first thing that came to mind was how I spent several months after Jamil’s birth. I self-isolated then, holing myself up in my flat, barely leaving my bed, eating crap, watching tv all day, ignoring calls from my friends and family and sobbing uncontrollably. Leaving the house to go to the supermarket filled me with anxiety and dread; I even avoided spending time in my garden for fear of being seen by neighbours. I totally and completely shut down, and could feel the dark cloud of depression, so very familiar already, not hover above me but envelop me totally.

Throughout that time, my friends and family were a constant. They called, they checked in, and at least once a week, I managed to get out from within the black cloud and go and meet someone for a drink or dinner. I went to therapy once a week too, a life line. I truly believe that those outings saved my life. I don’t think I would have survived without them, or what kind of shape I’d be in now if I hadn’t had that love and support.

Being indoors and locked down is a different prospect for me. It’s not that I hate the idea of being indoors all the time, it’s that I love it. The traumatised child in me loves nothing more than the idea of being safe and secure, alone and away from all people and potential pain. But that’s the problem: I have worked so hard at changing that, at trying to engage with my inner child so that she understands how other people help with the pain, that going back to self-isolation is terrifying. I dread what it would do to my mental health, I can see the black cloud (it’s always going to be somewhere in my vision I think) and it longs for the limelight once again. As attractive as self-isolating is to me and my depression, I feel I have to resist.

I did, however, do some research about getting back. I couldn’t get through to my airline, travel agent or insurance company. All flights from Thailand were booked, the only options being 35 hour+ journeys via Moscow or Hong Kong which cost over £1000. Even the emergency flight organised by the Dutch and French governments was full. Getting back to Europe would be extremely difficult and risky (you obviously have a much higher chance of catching Coronavirus on a plane with hundreds of people and recycled air), and all that would be waiting for me on the other side was self-isolation and a potential mental health breakdown with little to no medical support for that.

On the other hand, staying in Thailand also has its risks. The country, although the richest in South East Asia, is still poor and the health service’s capacity to deal with an epidemic is extremely limited. The Thai government wasn’t elected, the Prime Minister is an Army General, and state repression in the case of an epidemic is a given (of course, it’s somewhat arrogant to think that European countries are “above” such tactics too). Tourists and foreigners could be targeted, and we could be forced to leave the country with nowhere to go.

Both choices came down to where I would like to be locked down and I chose Thailand. On Koh Tao, I found myself a room in a house share. I have my own room (I didn’t realise how much I missed having a cupboard and drawers), bathroom and a terrace with a desk overlooking the jungle. I share a kitchen with 6 others, all but one foreigners who have also decided to stay put for a while. There are 3 dogs, countless geckos and butterflies, birds and crickets constantly serenade us. For the moment, I can still walk to the beach and go snorkelling with baby sharks and turtles. I have fiber optic internet so I can have WhatsApp dates with friends and family, and once a day read the terrifying news coming out of the world. I cook my own food using beautiful (and bountiful, the Thais haven’t emptied every shelf of food and toilet paper) local ingredients, and I’ve even found a shop with local and non-local organic produce.

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(From top left to right) View from my desk, my Gecko neighbour, the first meal I’ve cooked in 6 weeks and a haul of shells from the beach where I swam with baby reef sharks

I’m settling into my life here, developing routines I didn’t realise I missed. I am writing, meditating and watching Netflix. I feel anxious, but not all the time. I have the space to think and reflect on the trials I’ve gone through in the last 18 months and I don’t feel guilty for wallowing when I need to.

The black cloud is there, I acknowledge it every morning, but for the time being sun, sea and nature are taking centre stage. I am incredibly lucky to be here during this crisis, I know. I am choosing to think of it as the reward I am giving myself after the trials of the past few years.

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