She had odd COVID-19 symptoms. 8 days later she was gone.

Michele Franzese Rustigan told her big sister goodbye over the phone.

It was the afternoon of April 10, and Rosemarie Franzese was unconscious at Sunrise Hospital and Medical Center. Hanging up, Rustigan, 67, was in shock. But she also felt a wash of relief.

Yes, she wasn’t able to be with her sister — the two were extremely close — and yes, Franzese wasn’t awake. But at least Rustigan was able to tell her that she loved her, and give her permission to go. Then the light bulb went off.

“She was deaf,” Rustigan said with an ironic laugh. “I didn’t even think of that.”

“But I think she heard me in her soul,” Rustigan continued, her voice starting to break. “I have to believe that.”

Removed from a ventilator, Rosemarie Franzese died from the coronavirus about 10 minutes later. “Ro,” as her sister called her, was 70.

“My sister is a fighter, and I really believed that she was going to fight it off, that she was going to make a comeback. And when that doesn’t happen, it’s super weird,” Rustigan told the Las Vegas Review-Journal last week. “I’m at her house right now — it’s only my third time being here since — and I still think she’s going to walk through the door.”

Strange symptoms

Rustigan has no idea how her sister got sick.

Franzese, who spent her mornings and afternoons safely shuffling Hal Smith Elementary School students across busy intersections as a school crossing guard, hadn’t worked in about a week, since schools were closed.

Outside of work, or the occasional grocery trip, the longtime former hairstylist and avid New York Yankees fan didn’t get out much.

“She was a good person living a very simple life, just getting by,” Rustigan said.

She thinks her sister fell ill around April 2. It wasn’t shortness of breath, or tightening in the chest, or a dry cough, though, she said. It was diarrhea — so severe that even the act of standing up would cause Franzese to soil her pants.

At night, she would also grow confused. During a visit to her sister’s east Las Vegas home, for instance, Franzese began to trail off mid-conversation, unable to string three words together, Rustigan said.

Concerned, Rustigan called 911. Paramedics determined Franzese was extremely dehydrated, but because Franzese was coherent enough to answer their questions and did not want to go to the hospital, they could not take her.

“I was really angry with her, because she kind of laughed and said, ‘I’m fine, I’m fine, I’m just a little dry. My mouth is dry,’” Rustigan said. “I said, ‘You’re not fine.’”

New research

Rustigan never considered it was COVID-19. Her sister didn’t either.

Once more, two days later, a relative called 911 when Franzese seemed confused and disoriented, and once more, Franzese refused to go to the hospital.

About 3:45 a.m. on April 6, though, a relative called 911 a third time: Franzese was moaning and groaning in her sleep but would not wake up.

That time, she was unable to refuse paramedics, so an ambulance finally took her to Sunrise Hospital and Medical Center.

Upon arrival, she showed extremely low oxygen levels and was immediately put on a ventilator.

“What they saw, to them, must’ve been COVID all the way,” Rustigan said, noting her sister tested positive a day after being admitted to the hospital. “But the symptoms I was hearing on the television? It wasn’t any of those symptoms.”

According to an April study out of Stanford Medicine, it appears COVID-19 may sometimes present with gastrointestinal symptoms, including diarrhea.

The study was featured in Gastroenterology, a medical journal that focuses on gastrointenstinal disease, as part of a larger analysis that grouped together more than 100 similar studies, all of which found similar results.

Stanford fellow Alexander Podboy, a doctor and co-author of the Stanford study, said all Stanford patients who developed gastrointestinal symptoms either first had respiratory symptoms, or they developed respiratory and gastrointestinal symptoms concurrently.

But that may have been a product of who was being tested at the time, Podboy said, since Stanford only studied positive patients, and the threshold for patient testing amid a national testing shortage still focuses on respiratory symptoms.

Podboy said the study does not mean anyone who has diarrhea may have COVID. But the findings do make a case for the medical field to increase its threshold for COVID suspicion, and “make sure that we look globally at each patient for their entirety of symptoms.”

She had rallied

Franzese never regained consciousness. At one point, she seemed to be rallying. Then her lung collapsed.

With permission from Rustigan and their brother Vincent, hospital staff removed Franzese from the ventilator about five days after she was first admitted. It all happened so fast.

“We were desperately trying to get her help, but it wasn’t working,” Rustigan said. “I don’t want to think that if she had been treated earlier, she would have lived, but I do think that.”

Rustigan feels fortunate that no one else in her family got sick — not even Rustigan’s son and his girlfriend, who were living with “Ro.”

But even in a pandemic, when so many families are going through similar experiences, Rustigan also feels “very singled out.”

“I hate death in general, and the world goes on,” Rustigan said. “But I do feel like the dead are just a number to the country and the world.”

Maybe that’s because, until it happens to you, you might be feeling safe, Rustigan said. Separated, even. Like she and her family did, until Franzese was put on a ventilator.

Now she feels resentment. Anger.

“My kids are devastated. My grandchildren are devastated,” she said. “It’s just horrible.”

A previous version of this story said Rosemarie Franzese died March 27. She died April 10.

Contact Rachel Crosby at rcrosby@reviewjournal.com or 702-477-3801. Follow @rachelacrosby on Twitter.