We are in a bizarre state of limbo within the crisis. We feel hopelessly behind, yet still attempt courageous efforts to be preemptive. My residency program, for example, had a fantasy of identifying which services were essential and which were not, staffing physicians appropriately, and staggering work hours to minimize exposure and allow others to be available for back-up when some inevitably fall victim to either quarantine or the virus itself. Imagine our dismay when we, overnight, lost five residents to quarantine. Imagine how our morale tanked when we realized that all we had were our text messages, that we could not be there in person, could not feasibly “cover” for one another. We suddenly felt we were not teams but individuals, numbers waiting to fall, and we were, more or less, on our own.
Even somewhat isolated, I feel some sort of belonging in the hospital. Here I’ve had the privileges of seeing the best and the worst of humanity, and for that show, COVID-19 has built a particularly large stage. For every physician who is risking his/her life to be on the front line, I’ve heard one say, “I didn’t sign up for this.” Resentments escalate quickly as we blame our departments for not providing enough protection, others blaming the government for a lack of guidance, and us all judging each other for how we’ve chosen to respond, or not respond. Those who are choosing to distance themselves are shamed for being selfish, and those who are working overtime are shamed for being “martyrs.”
Complicating our response, the responsibility over life, and the potential for risking our own have triggered memories of losing patients in the past. There is nothing more painful than knowing a patient’s poor prognosis, and being able to offer nothing. We’ve been taught to internalize this guilt, however, because we can’t afford to be lost to failure. So we learn how to deliver bad news like letters we didn’t write, and wash our hands frequently. And when a crisis like this occurs, we don’t respond like heroes. We respond like veterans from a war that their country didn’t realize they had fought. The crisis feels like a nightmare, with all the feelings of failure and inadequacy that we were told to keep to ourselves.
Our spirits and bodies are deteriorating. My close friend in family medicine told me she hasn’t slept in two days. My other friend, who is an infectious disease fellow, said she’s never felt more burnt out. I haven’t in slept more than three-hour increments for the past week. I go to the grocery store worried I might be carrying the virus and exposing innocent people, and leave after buying groceries I don’t have time to cook.
There is this glimmer of humanity among those mourning the loss of control. The agony of defeat is but a reflection of how much determination remains within us. After waves of person after person who could not look me in the eyes, I’m humbled by the ones who did. The Medicine Senior who listened to me and did what he could. The ICU resident who looked up from her hands, chapped and chemical-burned from repeated hand sanitizing, and apologized for not being able to help me find a bed for my patient. All their beds are full. I tell her it’s not her fault. And then we wished each other luck, because we know we both need it.
I think of Antoine de Saint-Exupery’s words that were equal parts somber, and revering: “Perfection is achieved, not when there is nothing more to add, but when there is nothing left to take away.”
I think about how, in these vulnerable times, we are stripped of our resources, our science, and our egos, and left only, perhaps, with our purpose. The thing that keeps us waking up from our short naps, the thing that makes us show up to work, the thing that gives us something to protect, something to fight for, something to win. Perhaps it is that thing which will help us realize we were never selfish, or martyrs, or alone. We were just human.
It’s 2 a.m., and I’m sitting across from my patient. She used to be a nurse. Well-groomed, both she and her space are tidy. She shuffles carefully around her bed in a hospital gown and slippers from home. She’s been diagnosed with recurrent cervical cancer, and just yesterday made the decision to not receive chemotherapy. Despite spiking high fevers, she is cheerful when I see her. She’s regained her appetite. “Salt,” she proclaims, “is the answer.”
She slaps her own veins and, as I try to place an IV, makes me feel better about myself. “You’re not going to try. You’re just going to do it.” And as we approach an hour of attempts, of failures, and finally, a couple victories; as we both sit in silence watching her blood drip slowly, at a rate insufficient to call promising, into a blood culture vial; she lets out a sigh of relief. “Well, it’s been a journey.”
And isn’t it just beginning.
Jenna T. Nakagawa is a resident physician who blogs at her self-titled site, Jenna T. Nakagawa, and can be reached on Twitter @JTNakagawa.
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