Arrival to isolation room 45: Recently diagnosed with COVID-19, brought in by ambulance for re-evaluation.
I don my new uniform of colorful barriers: red-rimmed eye shield, green N-95, yellow gown, purple gloves. I carefully walk through two sets of doors into the room and find the most sterile spot. I used to touch, shake hands, sit; now I stand on a clean tile away from his bed.
“So I see you were diagnosed with COVID-19 just a few days ago, what made you call the ambulance today?”
“Oh, I didn’t.” He looks tired, but not in the sick, flu-like way that I’m used to. “I’ve been holed up in my house since I got diagnosed and my family hasn’t seen me in a few days. They came around today to wave through the window, and I guess they just thought I looked bad so they called 9-1-1.”
“And how do you feel?”
“Better, actually … but lonely. And scared. My sister has a cough and she’s already fighting cancer. I just want to see her …” He trails off.
Medically, my job here is easy. If his symptoms had progressed to the point that he was breathing too fast or not getting enough oxygen I would admit him, but he’s recovering well. Nevertheless, I go through the motions and walk to him, putting on my disposable stethoscope like headphones. Deep breaths in and out, in and out — it’s a guided meditation more than useful clinical information.
I see him speak but through the stethoscope it just sounds garbled and noisy, like he’s speaking to me behind glass. “I said, can I just go home? I really don’t want her to come here, and if I can tell them you said I’m okay, we can keep counting the days until I can hug them.”
He left, from an isolation room back to an isolation home. I stripped back down to just scrubs and moved on as if everything were normal, but the reality is that recently, the emergency department where I work has felt different. The usually chaotic but tamable ethos has been replaced with a tense mixture of dread and unknown. It’s all understandable: there is a dearth of protective equipment and testing, predictions of the COVID-19 pandemic are grim, and the effort we will have to make as a society is unprecedented. Yet, what has struck me the most as an ER doctor has been the humanity that I’ve seen in my patients.
In the past few weeks, I’ve treated many patients with a runny nose and anxiety. I have also treated patients with dangerously low oxygen levels who tried to go to work a few hours before their visit. Some people are scared, some are defiant. Some believe the experts, others believe this is somehow related to 5G networks. This is nothing new. We know that we give in to our most basic instincts in these apocalyptic moments. Are you the indignant, fighting type? Read up on conspiracy theories and stock up on guns. Anxious recluse? Lock your doors and binge Netflix. Have irritable bowel syndrome that is triggered by existential threats? Hoard rolls and rolls of toilet paper.
But this threat also seems to have driven some of us to reflect a bit more deeply on our lives. When I first started talking to patients about quarantine precautions and social distancing, I anticipated disbelief and misunderstanding: Accusations that medical professionals were overblowing this whole thing or claims that it doesn’t matter since a healthy person may just have flu-like symptoms. Though I am sometimes met with those views, I am also met with insightful, philosophical questioning. Isn’t it unreasonable to exist at such great social distances for an indefinite period? Will the care of non-COVID patients suffer as we focus all of our energy on this virus? Do the benefits of using this extended time off of work to see my aging parents outweigh the risks? Can I just go home?
More than ever before, I’ve been having discussions with patients about visiting rules and recommendations for how to safely see family and friends. Since our hospital reasonably stopped allowing visitors, I’ve had a few patients leave against medical advice because they wanted to be with their families. They’ve told me, just two eyes underneath a facemask and translucent yellow cloak, that they would rather leave this world next to their families than alone in a sterile building full of anonymous, masked figures. I have seen people, between coughing fits, do the hard calculations on the spot and make an impossible decision that weighs their own health, the health of their loved ones, their finances, their values, their animals, neighbors, community; the list is endless and daunting yet people are trying to figure it out with poise.
I don’t mean to romanticize this pandemic; this is and will be tragic. Large swaths will live through undue suffering. COVID-19 has revealed to us, among many things, the fragility of our health care system, social safety nets, and society at large. However, within this tragedy and underneath all of the statistics there are real people admirably grappling with their new realities. I once cynically thought that when people stared into an abyss, their basic instincts would be entirely selfish or irrational, but now that I’m watching it happen I think that I was wrong.
Zayir Malik is an emergency physician.
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