The unseen debt of the pandemic


Some images stick in the mind as unreal and incandescent things, despite their lived experience. My mind holds onto the gray-haired woman, stooped from age and wearing the hospital-issue facemask, standing alone with her hands clasped tightly behind her back. She was peering through the window of the door to her husband’s ICU room where he had just died. I joined a small group of nurses to hold a distant vigil. She looked brave as she stood in our dedicated COVID-19 ICU, but I felt nervous. I imagined the nearby swirling viral particles and desperately wanted to scoop her away to a safer place. I wouldn’t dare, of course. Visitor restrictions and safety measures had made these her only frightening, precious minutes to say goodbye.

Standing there with her, I felt a rush of sadness and some strange feelings of gratitude. Almost exactly one year before, I had been standing in front of my own loved one’s ICU door. The pandemic wasn’t disrupting lives that spring, but my life felt uprooted. After a years-long battle with a neurodegenerative illness, my dad had had his first seizure. The seizure spread swiftly and stubbornly into status epilepticus, and after a long and ineffective trial of countless medications and deep sedation, I made the choice to compassionately extubate him.

In the middle of that grief, I wouldn’t have ranked gratitude at the top of my emotional list. However, caring for patients and families in the COVID-19 ICU has made me feel differently. I do feel that I was lucky. I was lucky to have had more than a few, anxious minutes with my dying loved one. Lucky to have spent long nights at the bedside, wringing hands and holding hands. Lucky to have participated intimately with my dad’s journey toward death, so that I had the peace of knowing that we made the right choices on his behalf. I wanted all of those things for her.

I called her twice that evening, and each time, I was shocked by the stark silence on the other end. Where was the soothing chatter of loved ones, gathered around to comfort her? It took a few moments to process, but of course, I knew that she was grieving under her own quarantine. Her husband had exposed her to the virus a week before, and she was kindly ensuring that no other loved ones would meet his unfortunate fate. There would be no healing moments spent with her family, squeezed tightly and lovingly around the dinner table. This loss of physical community during deep grief, this secondary and invisible loss, is immense. And many are grieving in the same way right now.

With an economic recession looming, politicians and economists are calculating the losses. We’re weighing human lives against economic security. We’re grieving losses from the virus, police brutality, racial injustice, and economic injustice. All of the pieces are absolutely crucial and overlapping, but we might be missing a significant portion of the calculus. There is a cost to be reckoned with when we can’t physically hold each other close in moments of immeasurable collective grief. The emotional debt is compounding with each passing day, and, harder still, there is no perfect way to pay it. It will require us to be creative and intentional to heal. The dilemma is ongoing and ever-changing, but this virus is forcing us to recognize the incredible importance of coming safely, deliberately together.

Camille Spears is an internal medicine resident and can be reached on Twitter @CamilleESpears.

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