COVID-19 hits four generations of one Republic family: Family shares terrible toll
On July 6, Angela Hughes and her two teenagers, Madison and Mason, boarded a plane at Springfield-Branson National Airport. They would fly to Chicago, then Dallas and ultimately to Brownsville.
By land, it's 950 miles from Republic, Missouri, to Brownsville, a Texas city on the Mexican border.
They would make this trip despite the fact Hughes, a 46-year-old single mom, was worried about COVID-19.
She and the children already had self-quarantined for four consecutive weeks — two because they had been out-of-state in March and another two because Madison's boyfriend had possibly been exposed to the virus and, in turn, had possibly exposed her.
But the July visit was a special occasion, Hughes said. It was to honor two birthdays: Her mother would be 67 on July 7 and her grandfather 90 the next day.
“We knew we would take a risk with flying," Hughes said.
On a trip to celebrate life, the virus found them. It infected four generations of her family.
Hughes would end up fighting for her life at Cox South. Several members of her family also tested positive; not all would survive.
Hughes's first surprise was that the flights were packed with passengers. She had expected the opposite.
"There was a girl with her mask below her chin while boarding the flight to Chicago and she talked on her phone the whole time," Hughes said.
Hughes said her mother and grandfather live in a retirement community of individual homes where most residents travel by RV during summer and live in the community in winter. Her grandfather stopped traveling years ago and lives there full-time.
Since March, Hughes said, the only time her mother or grandfather left home was for doctors' visits. They had groceries delivered to the house.
"She was not thinking about herself," Hughes said of her mom. "She was thinking about her 90-year-old dad."
Her grandfather, Bob Hughes, still had an RV. That's where Hughes's 61-year-old uncle (her mother's brother) stayed during this small reunion.
He lives elsewhere in Texas and had arrived three days earlier on Friday, July 3, she said. He made the trip with a family friend.
A year prior, Hughes's mother had moved to Brownsville from Cassville to care for her father, whose longtime girlfriend had just died.
That first night in the house, Hughes did not sleep well. All she heard was the sound of her mother's cough.
"He was sick and he was stubborn"
The next morning was her mom's birthday. Her mother, Beckey Lundholm, had a low-grade fever, in addition to the new cough. She also has diabetes.
“I said, 'Mom, that does not sound good. I know it’s your birthday. Why don’t you stay in your room and we’ll see how this plays out?'
“She honestly did not feel that bad. She thought it was just a summer cold.”
Hughes convinced her mom to go to the emergency room in Brownsville to be tested for COVID-19.
Also that day, she noticed her grandfather had developed a slight cough.
She also visited with her uncle, who had been spending most of his time in the RV.
"He was visibly sick. He was in that RV sleeping a lot."
The next day, July 8, Hughes said, her uncle felt even worse.
"He was very sick and vomiting that morning."
She spoke to his friend, who was also staying in the RV.
Hughes said the friend told her that her uncle was already sick when he left home Friday.
"He was sick and he was stubborn," Hughes said of her uncle.
The only time anyone in the family wore a mask during their three-day stay was on July 8, when a few neighborhood friends visited to celebrate her grandfather's birthday.
The next day, Hughes and her children left Brownsville, as planned.
At the Brownsville airport, Hughes and her children had their temperature taken before they could board. They felt fine and were allowed to get on the plane.
"I did not have a fever. I was normal."
But she did have a slight tickle in her throat.
Suddenly, COVID-19 hits hard
On the trip back, Hughes and her children had just boarded the plane in Dallas for the flight to Springfield.
Her mother texted to report she was positive for COVID-19.
"For some reason, I felt strongly that it would be positive," Hughes said. "But I was hoping that my mom would be able to tell the story someday of how I overreacted and that she was fine and that I had made her go take the COVID test for nothing."
On the descent into Springfield, the virus struck again; it hit Hughes like a bullet train.
Hughes sat in the window seat next to her 19-year-old daughter. Her 16-year-old son was one row up on the aisle.
“When we started to descend in Springfield I got chills. My teeth were chattering. I knew then I had a fever," she said.
"My head started pounding. I have migraines a lot, but this was like nothing I had ever felt."
Her daughter had a sweatshirt in her lap. Hughes took the black "Friends" sweatshirt and buried her face in it.
"I was absolutely convinced I had COVID and prayed that I would not spread it."
Madison was terrified by how sick her mom was and how fast it happened.
"I didn't know how I could help her," she said. "There was nothing we could do. We were on a plane."
Yes, Madison said, it occurred to her that she and her brother might be infected, too.
“But that wasn’t really my main concern."
She said she did not believe she would get sick.
“I just saw how it was affecting my mom so quickly and I was not experiencing the same thing.”
Hughes got home and immediately took her own temperature. It was 103.5.
Both children show symptoms
Hughes called her nurse practitioner the next morning and was tested on Saturday, July 11, even though she already was convinced she would be positive — she was.
"My cough is worse. My head is pounding."
Both children showed their first symptoms on this day.
Mason had a low-grade fever and slept much of the day. Madison appeared to have a sinus infection.
Both would subsequently test positive for the virus, as would Hughes's 90-year-old grandfather in Brownsville and her uncle.
"My mom texted that it had finally hit her and she was really sick. Hers was initially mild. It hit me head-on."
By the end of the day on July 11, her mother was sending texts of only one word. The next day she did not respond at all.
Hughes called her grandfather, who uses a wheelchair. He checked on his daughter (Hughes's mother) and reported she was "very sick" and that he was worried about her.
"He got her on the phone with me and she sounded horrible," Hughes said.
Hughes told her mother to call an ambulance.
"You are being stubborn," Hughes told her.
Hughes prevailed; her grandfather called an ambulance, but when paramedics arrived they would not take her mother. According to Hughes, the paramedics told her mother she needed to be in worse health.
The Brownsville area was a COVID-19 hot spot overrun with cases, Hughes said.
"They told her she would have to be breathing like a fish out of water."
Meanwhile, Hughes could barely walk. She did not know at the time that the oxygen level of her blood was critically low.
"I was thinking of calling an ambulance but I thought of what the paramedics told my mother in Brownsville. That I would have to be breathing like a fish out of water."
She did not call.
On Monday, July 13, someone from the Springfield-Greene County Health Department called Hughes and asked how she was doing. That same night, the department dropped off a pulse oximeter, which measures the saturation of oxygen in red blood cells.
The person from the department texted to say the device was left at the front door.
Unfortunately, Hughes said, she received no explanation as to what type of reading would be cause for alarm.
Hughes is a professional photographer. The next day she posted a photo of her pulse oximeter reading on a Facebook friends group of fellow photographers. This was July 14.
A friend saw it and demanded that Hughes have Madison immediately call an ambulance.
Her daughter did that, informing paramedics her mother had COVID-19. Hughes was taken to Cox South.
"I was really out of it and not very coherent."
In the emergency room, it was discovered she had double pneumonia, an infection in both lungs. At 4 a.m. Wednesday, July 15, she was moved to the Cox COVID-19 unit.
Her mother's condition also had worsened; that same day in Brownsville she was admitted into the hospital.
By that evening at Cox, Hughes thought she was dying.
“I did not think I would wake up that night. I really thought I would be gone."
She was given oxygen. She was not placed on a ventilator.
“I prayed that the right people would come into my children’s lives and help them to get through this. I prayed that the virus would not hit my children as hard as it had hit me. I prayed for peace and God's will."
A fight for life against COVID
Hughes provided the News-Leader with a summary of her treatment at Cox but she warned that at times she was groggy and her memory is foggy.
She said she was moved to intensive care and that she used what she called a "rebreather mask."
She said she was given convalescent plasma but that it did little to improve her condition. Convalescent plasma is the liquid part of blood that is collected from patients who have recovered from the novel coronavirus disease. COVID-19 patients develop antibodies in the blood to fight the virus.
She received dexamethasone. According to the World Health Organization, this is a corticosteroid used in a range of conditions for its anti-inflammatory effects.
What seemed to work best, Hughes said, was the drug remdesivir, which now seems to be the only current effective medication for COVID-19. Experts caution that it’s no “silver bullet” against the disease.
Hughes said she was also given morphine because she was in pain. Her sides and chest hurt.
The News-Leader contacted CoxHealth in an attempt to ensure the paper was accurately reporting how the hospital treats COVID-19 patients in general. Hughes's recollection was admittedly foggy.
At a time of much misinformation, the newspaper wants to get things right.
The paper asked in an Aug. 10 email general questions about COVID-19 treatment. A News-Leader reporter told the hospital he had talked to a former patient, a Republic woman, but did not provide the name.
The newspaper asked, for example, what a "rebreather mask" was.
Cox spokeswoman Kaitlyn McConnell said the hospital would not answer questions and indirectly referred to HIPAA regulations.
She wrote: "It would be difficult for us to supply information that would not appear to confirm/deny her experience, even though we don’t know the specifics of her case, and that could be problematic given the many variables that come into play."
In turn, the News-Leader contacted Dr. Dima Dandachi, an assistant professor of clinical medicine at the School of Medicine at the University of Missouri. She is involved in the university's research in the use of convalescent plasma to treat COVID-19 patients. She is on staff at University Hospital.
She was asked generally about the treatment of COVID-19 patients.
Dandachi said there are various ways to try to increase a patient's oxygen level, such as intubation or mechanical ventilation. One option is a "nonrebreather mask" — not a "rebreather mask."
(CoxHealth did not convey this mistake to a reporter who had asked in an email about the general use of a "rebreather mask." Both types of masks exist.)
The mask's function is similar to an oxygen mask that drops during airplane emergencies, Dandachi said.
COVID-19 patients who are moderate to severe will often receive remdesivir. Dandachi said the drug is an anti-viral medication and is given intravenously, usually for five days.
"There is no oral pill," she said.
Convalescent plasma for COVID-19 patients is still under clinical trial, she said. What that means, she said, is that doctors seek consent from patients or their family to use the plasma after explaining risks and benefits.
It should be noted, she said, that the overall practice of using plasma from recovered patients has been around many decades — but its use for COVID-19 patients is new only because COVID-19 is new.
Dexamethasone combats inflammation in COVID-19 patients, Dandachi said.
It's not just the virus that attacks patients, she said. The virus can lead to serious complications, such as inflammation of the lungs.
She stressed that much is unknown about COVID-19.
"It's a moving target right now," she said.
"Very scary and very lonely"
During her treatment, Hughes lost track of her mother's battle against the virus.
“I did not know what was going on because I was fighting for my own life."
During the nine days Hughes was hospitalized, her children were alone in the house.
Their father visited regularly but did not enter. The couple divorced in 2010.
Friends brought meals to the children. Hughes's nurse practitioner, Teresa Sondermann, also checked on the children via phone and Facebook Messenger.
Madison, who missed her senior prom at Republic High, ran the household.
“It was very scary and very lonely," she said.
Neither child needed to be hospitalized.
Hughes credits her Cox doctors for saving her life. She mentioned Dr. Robin Trotman, a specialist in infectious diseases, and Dr. Chase Ellingsworth.
"I want to thank everybody at Cox South," Hughes said. "I got really great treatment. I wish I knew all their names. You can't really see the faces; all you can see is their eyes. They are risking so much to take care of us."
Hughes felt much better but was still in the hospital July 21 when her brother called to tell her their mother was on a ventilator in Brownsville and had gone into cardiac arrest twice.
"She was not coming back," Hughes said. "He called me to let me know they were going to let her go and he called back after she had passed."
Beckey Lundholm died that day at age 67.
"The thing that I loved the most about my mom was the way she thought about others," Hughes said. "Mom lived a hard life. She was financially poor. But she always had a gift on a holiday or on a birthday.
"By a 'gift' I don't mean she bought anything. It was always something that was very sentimental and something from her heart."
Her grandfather did not need hospitalization. The family is unsure who will care for him.
"As of now, we don’t know what the future is with grandpa," Hughes said.
Hughes was released from Cox on July 23.
“I did not know how long I would be in recovery. They really do not know everything about this disease. They said if I started to feel worse to come back.”
Hughes said her uncle was told to leave by the managers of the retirement community in Brownsville. He went home and was hospitalized for COVID-19. He has been released.
His friend tested positive but never became sick, she said.
Trying to find forgiveness
On Monday, Aug. 10, Hughes returned to work for the first time since her hospitalization.
Her business is Artistic Photography, which she started after her divorce.
She said she has been devastated financially by the disease.
She has health insurance but had to pay a $4,000 deductible. She has not yet received all her Cox bills.
“I had already been out of work from the stay-at-home order," she said. "I followed those rules. I did not take on any sessions. ... Obviously, that can devastate a small business.
“Then I got hit with COVID, not just quarantining. It just took everything."
After two phone interviews, a News-Leader reporter met in person with Hughes Wednesday night at her photo studio at 224 N. Main St., in Republic.
Prior to that in-person meeting, Hughes was anxious and dismayed upon learning that the reporter would try to contact her uncle in order to hear his personal story about fighting COVID-19 and to ask why he would attend the family reunion if already sick, as Hughes said he was.
Hughes said she is struggling with how to repair her relationship with her uncle, who she believes was sick when he left home to go to Brownsville.
The News-Leader tried to reach her uncle via Facebook Messenger and through contact information provided by Hughes. He did not respond by deadline.
"I am just praying about it," Hughes said. "I know he did not do it on purpose.
“It’s because his inconsideration about coming around sick is really hard to deal with. Not only is my mom gone and I had a horrible time fighting for my life. There is so much more.
"I’m trying to find forgiveness."
Hughes posted parts of her story on Facebook on Aug. 2. She said she did so because she wanted to let others know the dangers of the disease are real and can be fatal.
"It's hard, especially when there are people that you personally know who know that you have just gone through this. And they say 'this is politics' or 'the numbers are false.'
"Did you not see what my family just went through?
"When they say it is just a 1 percent fatality rate, well, if your family is that 1 percent it makes a big difference. All this arguing. It's just the way this world is. And I know there are going to be arguments when your story is published. There are going to be people who disagree and they are going to be ugly about it."
In fact, Hughes said, she was dumbfounded by the posts made by her uncle in Texas.
She is a Facebook friend and pulled up his Facebook page. She showed several memes he has shared — even after the death of Hughes's mother, his sister.
She pointed out one that had a photo of a mask placed snugly over a beard. It said: "Wearing a mask over a beard looks kinda like a women’s underwear ad from the 70's."
"He posted that the day after my mom died," she said.
News-Leader columnist Steve Pokin has been at the paper eight years, and over his career has covered everything from courts and cops to features and fitness. He can be reached at 417-836-1253, email@example.com, on Twitter @stevepokinNL or by mail at 651 Boonville Ave., Springfield, MO 65806.