A Doctor’s Plea: We Are Reopening Too Soon
On lifting restrictions while still in the trenches
The hum from the HEPA filter is so loud, it’s as if she’s on a different planet. She hears nothing. It’s night outside, and the room is completely dark. I turn on a few lights, enter in head-to-toe personal protective equipment, the oversized gown over gloves and boots consuming my small body such that I am hardly humanoid. The only areas of visible skin are the few centimeters around my eyes behind a giant face shield. I approach her and wave, uncertain if this is how to signal that I come in peace.
I introduce myself as her doctor.
“What?” She leans forward. I scream at her that I’m her doctor. I tell her the results have come back from the swab we collected when she came to us in labor. She is positive for Covid-19. She leans back and stares at the ceiling.
It is still possible to recognize emotional collapse, even with half the face hidden behind a mask. Her eyes fill with tears. “I don’t understand,” she says. I scream at her, “I’m sorry?” Still the hum is too loud. “I don’t understand,” she exclaims. And in this moment, she’s forgotten she’s in labor.
She has been withstanding her contractions without an epidural, holding off until her husband is there because she believes that with his support, she might not need anesthesia. Now, feeling more isolated than ever, the unprecedented pain of active labor has been quieted by the unprecedented stress of this test result. She starts telling me about her family, about how she’s done everything she could to stay at home and avoid people, about how her daughter is staying with her sister now while she’s in the hospital. She starts crying and asks me if she’s endangered her daughter, her sister, and her sister’s family. Again, she’s forgotten that she’s in labor. She may have even forgotten she’s pregnant.
We discuss visitation policies and her options for newborn care after she gives birth. She wipes her face, makes eye contact with me for the first time, and nods in quiet resolution. After I exit the room and take off my protective gear, the call signal from her room lights up. She wants an epidural.
Those who have lost colleagues, friends, and mentors have not been able to mourn them with a proper funeral … . They are needed instead at work, required to return to the bay that took their friends’ lives.
Covid-19 has changed everything about the way we experience our lives. With talks of reopening businesses and evidence of a flattening curve, it would appear there is a light at the end of the tunnel.
I understand the optimism. To say that we miss or even crave normalcy is a euphemism when masses are willing to become violent just to return to a lifestyle they prefer. My neighborhood in Brooklyn is decently cautious except on days with nice weather when everyone comes out in droves as if the virus would leave if we confronted it with an uprising. As the days grow longer and vaguely blend together, it’s never been more obvious that we are all fighting battles.
Ours, in the hospital, do not afford us such optimism about the return to normalcy.
I hardly watch the news because it appears like reality television, far too departed from my own reality. I can’t practice social distancing at work. I see more masked faces on an average day than some do in a week. I know that more masked faces does not equal more human interaction. I’ve pondered the psychological torment of, in times of stress and uncertainty, searching for reassurance among neighboring faces and not being able to find it in a sea of masks and blinking eyes.
And although the shoreline of our ICU has receded and our death rates have decreased, the flattening curve couldn’t feel further from a victory. In one week, the head nurse of our emergency room and one of our lead ICU physicians died from Covid-19. Those who have lost colleagues, friends, and mentors have not been able to mourn them with a proper funeral or even a day off. They are needed instead at work, required to return to the bay that took their friends’ lives.
It is the denial of dignity, at the end, that feels particularly merciless. We’ve been defeated, day after day, now desensitized to codes called over the hospital intercom, burnt out from every day feeling that we’re further and further behind, hoping for guidelines, hoping for resources, hoping to save people, and burnt out from hoping.
I asked one of my colleagues working in the ICU if things are “getting better.” In the stairway of the hospital, she peered at me through her protective goggles and mask. She couldn’t comprehend the question and shrugged, “Our ICU is still at the largest capacity it’s ever been.” The biggest fear among frontline workers is the inevitable surge of cases and mortality that will come once restrictions are lifted and businesses reopen.
Any of us who have lost someone to Covid-19 know that the well-being of our society cannot be projected in statistics and graphs. Every spike in cases on a screen or piece of paper represents real-life moments with patients that should never happen. Moments like phone calls, desperate for a next-of-kin to answer so that they can speak with their dying parent minutes before we intubate. Moments when we learn what regret sounds like over FaceTime. Moments when a phone battery dying could mean a life left wondering — one young man, eyes full of tears, begged me to give a phone charger to his mother as she was admitted to the hospital.
It is the denial of dignity, at the end, that feels particularly merciless.
Surges of cases mean working on the bodies of people who sheltered in place and “did everything they could” in addition to those who did not and simply wanted their lives to be “normal.” It means mourning our own health care workers, living in fear of becoming symptomatic and infecting those around us, and going out the way we see it happen — too quickly, under a rapid storm of lung injury, unable to say the things we want to the people we love.
I omitted a detail from the story of the laboring woman. The truth is she did have her partner in the room, supporting her through her pain. The saddest part of her birth story is that when he learned she had tested positive for Covid-19, he abandoned her. He couldn’t handle the stress of thinking he might be a carrier too. He left her alone at the hospital, never returned, and missed the birth of his son.
This story is heartbreaking, though not unusual in these times. Those of us fortunate enough to live through the crisis have been alone during major life events. Being denied the decency of going out for a cup of coffee occurs in parallel with missing childbirth, graduations, weddings, and funerals. If this pandemic has taught us nothing else, it is that we are not meant to be isolated. Being unable to celebrate, to mourn, to reassure, to access health care, and to hold one another is tormenting — we might start to believe we are not only unable but undeserving.
We are reminded that what we really need is to connect. After all the media fatigue, after the seemingly endless defeats in the emergency rooms and ICUs, in a strange war in which health care workers face off with the general public, possibly what will hurt most is not the defeat of our systems but the defeat of our humanity.
The end of the story is not that the laboring woman was in pain or that she gave birth by herself or that she was abandoned. The end of her story, as she would choose to tell it, is that in spite of everything, she remained healthy and gave birth to a healthy baby boy. The “light at the end of the tunnel” is not a metaphor for when businesses reopen or when our lives go back to “normal.” While we worked and stayed at home and protested and lived and died, our reality as we knew it — our so-called “normal” — took a new form. We have suffered unspeakable losses, but we have also won. We’ve added tremendous meaning to our relationships and learned to value one another more than ever, and the health care system has rarely seen so much generosity from the community.
Considering the enormous impact of what we have been through, we cannot look forward to a light at the end of the tunnel as mere business as usual. We’ve proved that we deserve, and are capable of, more than that. For those of us in health care, our ability to exit safely depends on everyone else’s willingness to stay home. Even after restrictions are lifted, common sense and courtesy dictate that people protect themselves and others, especially the most vulnerable. This pandemic is an opportunity to write our new beginnings, to do the right thing, to stay at home, put the mask on, and care for one another like we have everything to lose. Because we do.
