The Cater sisters’ last memories of their father are both poignant and remote, a monument to the horrors of COVID-19 and the expanded role it has thrust upon the health care staff seeking to meet the needs of patients and their families.
Based on Alabama Department of Public Health data, it appears Joe Cater was the second Morgan County resident to die of COVID-19. That number had risen to 20 as of Friday. Thirty confirmed or suspected COVID-19 patients were in Decatur Morgan Hospital on Friday, including five on ventilators.
Cater, 76, was a man who derived energy from the flock he had gathered around him. Every Sunday morning the full-time elder would preach at Bethlehem Primitive Baptist Church in Greenbrier, ministering through the week to his congregants’ needs. Every Sunday after church his family — children, grandchildren and great-grandchildren — would meet at his Trinity home for a home-cooked meal prepared by his wife of 52 years, followed by singing, bingo and cards.
But on June 11, Cater was in a coma, his organs ravaged by the highly contagious disease that doctors are still trying to understand. State emergency orders and medical realities — 97% of ICU patients at the time were infected by the coronavirus — prevented family members from being at his side. As he lay prone and intubated in a COVID-19 intensive care unit at Decatur Morgan Hospital, he was not surrounded by his congregants. His family members were not at his bedside, but at his Trinity home.
How is it that this moment that they did not witness is etched in the minds of Tracey Cater and Keisha Cater, and that it brings memories not just of pain but of joy?
Their memories derive from the kindness of Stacy Codding, RN, the transitions coordinator at Decatur Morgan Hospital specializing in palliative care.
On June 10, Cater’s COVID-damaged heart had stopped, family members explained. He was resuscitated, but his brain went without oxygen for more than seven minutes. Brain damage was inevitable, and the disease was also attacking his lungs and kidneys. Codding, who had been in at least daily communication with the family during the patriarch’s weeks in the hospital, advised them of his grim condition and scheduled a call for the next day.
“Miss Stacy called me that morning,” recalls Keisha Cater, 45. “We got everybody together at my mom and dad’s house and she called us on the phone. She dressed up in her PPE and went into his room, took her cellphone in the room with her and put her phone to his ear.
“We all took our time and told him we loved him, and that it was OK. We knew he had fought, and we knew the toll it was taking on him. We told him we were going to continue to take care of each other, and that he knew we were going to take care of our mom. We wanted him to know everybody was in a good place and that we were going to be there for each other no matter what.”
Tracey Cater, 52, communicated the same message to her father, as did his wife and other children.
“He was giving it all he had. I think he just needed to hear that we were going to be there for each other and love each other,” Tracey said. “I think he needed to hear that in order for him to take his rest.”
Added Keisha: “Stacy said, you can just tell a calmness came over him, like he just came to peace with it after hearing our voices on the phone. We thanked her, and she said she would call if anything happened.”
Four hours later, the call came. Joe Cater had died.
“Nurse Gayle (Stricklin) went in there and held his hand until he passed. She said she did not want him to be by himself. She wanted him to know somebody was in there with him. … Stacy said he just went peacefully. He knew that it was OK. I think by him hearing our voices it was easier for him to transition, because he didn’t have to worry about us anymore,” Keisha said.
For a family man, the timeline of Joe Cater’s battle with COVID-19 was appropriate. His first symptoms were on Mother’s Day, May 10. He died on his daughter Keisha’s birthday.
“The love they had for each other, you could just cut it with a knife,” Codding said. “It was palpable how much they loved him and he loved them.”
Codding also facilitated the family’s last conversation with Joe Cater, about a week before his death. When the pulmonologist concluded the only chance of saving Cater’s life was to use a ventilator, Codding understood the significance and initiated a video conference between the patient and his family.
“We thought it was key to make that happen, because with COVID patients, once you put them on a ventilator you don’t know if they’ll ever come off,” Codding said. “He got to see them and they prayed together. He got to talk to them, and it was actually the last time they heard his voice.”
An important role of a palliative care nurse like Codding is to provide comfort and information to the patient’s family, a role Codding said is usually done at the patient’s bedside. The contagious and deadly characteristics of COVID-19 have forced her to be a liaison not only between doctor and family, but between the isolated patient and family.
“I’m a Christian, and I pray every day that I serve the families well, that I do what I need to do to either bring them as much closure as I can or make them feel as involved as I can,” Codding said. “Do I cry? Sure.”
'It ravages a patient'
COVID-19 is unique both in its potential severity and in the isolation it requires.
“It ravages a patient like end-stage cancer or any other end-stage disease. It’s ravaging the whole body,” said Codding, who sees the most severe cases. “They’re so sick. Some of our older folks are saying, ‘Just send me back to die. I don’t want to do this another day.’ There’s a loss of independence because the sickest ones can do nothing for themselves. It’s so isolating because their families can’t be there.”
Joe Cater’s daughters don’t know how he was exposed to the virus. The church elder took the disease seriously, distributing dozens of cloth masks to his family and congregants, and switching to online church services.
His first symptom, on the evening of May 10, was a cough. It got progressively worse, and on May 13, Tracey — who was to contract COVID-19 soon after — took him to the emergency room at the Parkway campus of Decatur Morgan Hospital.
“He said he wasn’t feeling good. He was short of breath,” Tracey recalls. He tested positive for COVID-19 and was transferred to the hospital’s main campus. He seemed to improve and his oxygen levels were acceptable, so he was discharged May 16, a Saturday.
“He got out on Saturday, but I went in Saturday afternoon,” Tracey said. She tested positive and remained in the hospital four days. She was feeling better by then, and she hated the isolation of the hospital.
“Even in the hospital, you wouldn’t see people. You’d see nurses every six to eight hours because they only came in when they had to. I told them I understood that, for their own protection,” and it was also a time when hospitals were desperately short of PPE. “It was very lonesome in the hospital.”
Soon after Tracey quarantined herself in her home, her condition worsened.
“It all came crashing down on me. I had a fever of 104, extreme chills. Then I had the body aches and lost my sense of smell and taste, had insomnia and depression,” she recalls. Family members would set food on her porch and, when she was able, she’d wave to them through the door.
But by then, the Cater family was dealing with other issues. Joe Cater’s condition had gotten worse.
“He was feeling a little better the day before, but that Monday (May 18) he was coughing a lot,” Keisha said. “I think his fever was up to 104. He didn’t have any energy. He couldn’t get up and move around. He just felt weak.”
She took him to the Parkway emergency room, but could not enter with him due to COVID-19 isolation procedures. He was soon transferred to Decatur Morgan Hospital and, not long after, was placed in the intensive care unit.
“They kept telling us that as long as it didn’t affect his other organs, then he was on the good side of it. At one point he seemed to be improving,” Keisha said.
He talked by phone to his many family members daily. Codding called Keisha, the family contact, every day to provide updates on his condition.
“Every time I passed his room, he was on the phone with one of them,” Codding said. “The nurses would say he was always talking with them on the phone, until he would get short of breath and have to hang up. What broke my heart is that he went from sitting up, on his cellphone talking to them, to intubated and unconscious. You just watched that whole cascade.”
Joe Cater had resisted being placed on a ventilator, but eventually there was no other option. As Cater’s conditioned worsened, the hospital allowed limited compassionate-care visitation. That meant a family member could sit outside his closed room, watching him through the glass door.
“I saw firsthand what he was like on that ventilator,” Keisha said. “He fought. My mom and I usually took turns, just sitting outside his door. That’s the hardest thing I had to deal with, for us not to be able to go in there and talk to him and tell him we were there. It was tough to know he was there by himself, with only nurses that could go in there.”
After he coded, it was time for the family to make hard decisions. Doctors explained that he had brain damage from oxygen deprivation, the sisters recall. His ribs were broken from the resuscitation effort.
“They were expecting him to code again. Even if they had resuscitated him again, they said he would have to go to rehab for the rest of his life and be on a ventilator. He never would have been Dad, like we knew him, ever again,” Keisha said. “So we told them that if he coded again, just let it happen naturally. We didn’t want him to have to go through that again. He had fought long enough.”
Tracey, who has multiple health conditions that placed her at high risk, eventually recovered from the illness and was able to speak at her father’s graveside service.
She remembers her father, an Army veteran who was called to the ministry in 1984, as a vibrant and loving father.
“Anything that we had going on, he was there,” Tracey said. “Even when we were grown, if we needed something, we called Daddy. Daddy would make sure that it got done. Toilet stopped up: Daddy was coming over here to unstop it. Garbage disposal not working: Daddy bought a new one and installed it. Car wouldn’t start: Daddy would go buy you a battery. There has never been a time in my 52 years of life that I called my daddy and he was not there.”
‘This is real’
Tracey has come to accept her father’s death, but what she struggles to accept is the insistence by some that the disease is a hoax.
“This is real. We know it’s real because it hit home; it presented itself right on our laps,” she said.
Keisha said she does not understand the resistance that some have to wearing masks as the world waits for a vaccine.
“That’s what irks me the most: the comments people make about something as simple as wearing a mask,” she said. “That could save somebody’s life. If you refuse to wear a mask, that’s telling me you don’t care about anybody but yourself.”
Keisha said the issue has been politicized, but it has nothing to do with politics.
“If you could go up there and see the nurses in the ICU, running from this room to that and having to put on all their protective equipment, take it off, and put it on again; if you could see the patients in the ICU and what horrible shape they’re in; if you could have seen my dad on a ventilator; you would not refuse to wear a mask.”