From a clinician on the frontlines: I can’t stop mentally drafting my obituary

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I can’t stop mentally drafting my obituary. A coworker snaps a picture of me in full protective gear, holding a respiratory swab, and I wonder how this photo will age. I wonder about the folly of our actions now, four health care workers seated together at a computer bank in the emergency department. Likely seeding toxins back and forth as we idly banter during our shift, trying to stay calm for one another. I think of the scene in the Chernobyl series: The townspeople dancing on the bridge in a rain shower of radioactive particles, the nuclear factory aflame in the distance.

It is an eerie calm before the storm. No traffic on my way to work, military vehicles on the highway. Empty grocery store shelves. Suddenly aware of the vulnerability of my little family as I hunt for milk and diapers.

We are the expendable frontline infantry, holding antiquated bayonets, subjecting ourselves to who knows what. The information changes daily. The protocols change as the resources dwindle. The one-time-use disposable mask becomes my permanent keep, to use between every patient, to carry back and forth with me between work and home. I write my name on it and guard it because it’s the only one I may get.

We wonder how to clean these one-time-use masks. There are no guidelines, because they were never supposed to be cleaned, only immediately doffed and carefully thrown into the biohazard trash can. One of our nurses took the silica demoisturizer packet out of a bag of beef jerky and is storing it with his mask in a paper bag. Our assistant medical director recommended placing our N95s in the sunlight; perhaps the UV exposure will help. A Stanford research team suggests the oven.

We talk about creating our own masks. My colleague gives her mother-in-law a mock-up so she can sew some replacements when we run out. My cousin mails a package of colorful, hand-stitched numbers, which sit unused until the day the hospital allows them on site.

Gone are most of the principles of modern medicine. The facial expressions that I have curated to convey empathy and compassion are erased by the mask, the visor, the gloves, the gown.

We are told to stand as far away as possible from our patients—outside the room, even—because we can’t prove that the driver injured in a motor vehicle accident isn’t also transmitting the virus.

So, gone is my physical exam. I’m practicing in-person telemedicine, and I see the agony and alienation on my patient’s face. She cries and asks me why I am treating her like she has the virus. I tell her I’m trying to protect her from me. I probably have the virus.

It’s not you; it’s me.

We are marinating in anxiety. We nervously and guiltily greet our family members upon our return home, wondering if we are doing them harm, wondering if we should even keep living with them. Many have abandoned ship. But I can’t pull the trigger. I will perform an obsessive series of clothing changes; I will switch my hospital shoes when I get to the car, I will strip down and shower immediately upon arriving home but, selfishly, I can’t stop kissing my baby boy.

Several of us are already quarantined, due to exposures to known COVID positives. Most are being asked to come back to work now— just wear a mask. Your dirty mask. Soon I imagine we will be asked to stay even if we have the virus, as long as we are not too short of breath.

As I compulsively refresh the website that tracks daily case numbers, I do the math. Twenty percent of hospital admissions are for people ages 20 to 44. The story is changing before our eyes. If one in five of us goes down, our staff of 25 providers will grow a sinkhole that will suck others in as they grow exhausted and overworked. Our cumulative exposures will aggregate, threatening the entire institution.

Who will it be, then? Which of us will be the one who winds up on a ventilator, if it’s not already occupied? Minutes tick by slowly as we await the inevitable, aware of this game of Russian roulette that we play every time we go to work. Reality is a heavy weighted blanket; the curtain is closing out the light.

And yet, my heels resting in stirrups, I look upward at an ultrasound image and see the flicker of a heartbeat of hope. Radiating from inside of me, transmitting a reminder of miracles at a rate of 171 beats per minute.

We don’t know much of anything. We do know fear. We may know profound sorrow. But we also know love.

The author is a physician assistant. She is 13 weeks pregnant.

Image credit: Shutterstock.com

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