Sometimes the narrative changes. It completely flips. The whole reality of reality goes up in a wisp of smoke and all that’s left is a skeleton of experiences, lived and watched.
We all lived a slightly different year in the year 2020 than we had anticipated. We all have a skeleton of experiences, lying around us with its bones helter skelter, scary and formidable. We are scared to touch it but are also intrigued by why it’s even scarier and uglier than the standard skeleton. How could a skeleton, something which is so unsightly at baseline, become even more so?
I don’t know about you but I have been intrigued by the mysteries of this universe less than the usual person. I don’t have deep thoughts like many of you. I make assumptions and treat my assumptions as the word of God. Depth of thought isn’t my forte. This is part of the reason why death has been so devastating to me always. I can’t see the beauty of it. I can’t see it as the next great journey. I can’t even see the freedom that some get with death. I see it with time but in the moment, I can’t. I’m a superficial person on the best of occasions. So of course the death toll with COVID has left me reeling.
I’m a COVID physician. I’ve treated many. I’ve diagnosed many. I’ve saved many. I’ve lost many. In a cold, hard place called “the hospital”, my emotions have always had to run behind me. They can’t get ahead of me. For a physician, it’s an asset to feel and empathize. But if empathy could be engineered, we would’ve given it to everyone. So not all physicians have it. Those who have it practice a qualified empathy that we call Compassionate Empathy.
It’s a strange thing to see a disease for the first time. You diagnose it with fair ease because you’re working with a team of very experienced doctors and someone always knows what’s going on. Then you read up about it and look less like a fool. Then you see it again in another patient and diagnose it. Medical learning is the purest form of active learning. We learn a lot on the job. It’s not called a “practice” for nothing.
But what do you do when you see a disease that no one has seen before? What do you do when the disease is everywhere? What do you do when it’s nebulous? What do you do when it kills faster than we can breathe?
Many people ask me what, in my observation, the most painful feeling is. I have never struggled with the answer. The most painful feeling is struggling to breathe. The act of breathing is so spontaneous that we take it for granted. We have no practice of it. Gasping for air, catching their breath, pain when breathing, are not mere colloquialisms for difficulty with breathing. Gasping for air is painful to experience and watch.
COVID causes a lot of painful breathing. It causes shortness of breath. Of all the symptoms it could cause, it chose this. We keep increasing the amount of oxygen that the patient is supplied by artificial maneuvers and the patient still gasps and longs for more air to fill their lungs. They finally get tired. COVID-19 wins. My patient loses.
It’s hard for me to wrap my head around all of my patients who died. I’ve met tens of COVID patients, if not hundreds. I’m touched by how they’re still smiling, asking me to stand away from them, some even volunteering to speak over the phone with me to decrease exposure. Can I say that I have had trouble breathing too? Many times. My heart constricts and my lungs become spastic. I can’t get enough air. I want to cry but my patients are smiling. I can’t cry. So I smile and reassure them that they’d be fine. That I’m starting steroids and we will give them this trial drug and that and they’ll be out of the woods. They trust me and reassure me too. They tell me how they’ve lived through WWI and WWII. Some tell me how they lived through famine and draught before they immigrated to the USA. Some tell me stories of wars they fought and friends they made. Some show me pictures of a family waiting for them.
Not all my patients are war veterans. Some are not exactly spring chickens but were that just a few springs ago. They’re men and women in their thirties and forties with a mortgage, children and a job that they love. They tell me how they’ve been working from home and even though it’s new and sometimes tough, it’s so great to spend time with their families. I smile and chit chat and watch their oxygen dropping on the monitor. They’re not gasping…… yet.
I have to ask my patients what their wishes would be if we needed to resuscitate them. What it is that they would want me to do if their heart stopped or their breathing stopped? Would they like CPR? Would they like the ventilator?
I have learned a version of this speech by heart. Otherwise it got difficult for me. Sometimes I awkwardly mumbled the question and my patient asked me to repeat myself. Sometimes I just choked. I don’t choke anymore. I put up a brave face. Many COVID patients require the ventilator. I have clear conversations and insightful discussions. You could say I have become “clinical”.
I can’t touch them like I used to. In the past, I used to hug my patients if they wanted to. A transgender woman who was admitted by me three times in a year requested to see me one night. She had a terminal illness and wanted to spend the last of her days in the hospice unit. She wanted to hug me. In a world where she hadn’t had many to hug, she held on to a stranger for longer than anyone should hug a doctor in a white coat. Who knows what our white coats carry! But she was unafraid of any bugs I might have on me. She hugged and cried. She showed me pictures of the man she had hoped to marry. She wished more people had hugged her.
I’m thankful she didn’t have COVID for many reasons, the biggest being that she wouldn’t have been able to hug me. In a world where marginalization was stark against her, COVID was the one discrimination that didn’t happen to her.
Some of my COVID patients have other complications. When I tell them that their COVID is improving but their kidneys are getting worse or they have a blood clot in their lungs, I see a shadow cross their faces. Their sprint is slowly turning into a marathon and they’re exhausted.
Exhaustion is what I feel too. This week I felt uplifted and elated after a long time. A vaccine was approved under EUA (Emergency Use Authorization) by the FDA. My colleagues and I will be getting it soon.
So tonight I walk down the hallway of a COVID floor again. I look through the windows, patients alone in their isolation. They smile at me as I pass by, some wave, some even blow a kiss.
Some have met me when they were getting admitted and some met me because of one thing or the other. There is a glimmer of hope, a layer of darkness, a hint of a rainbow, a cloud of despair, all circling our heads at the same time. But overall, it’s the many colors of humanity. I strain to look past COVID and their once carefree, healthy faces stand out. There is hope after all, their good health assures me. They’ll be okay, Hope says in my ear. They’re stronger than you think, my books tell me. They’re still whole, our spirits do a happy dance.
Through the looking glass I wave too, and they smile more broadly. I blow a kiss too and their faces break into a grin. As I look through the looking glass, some of my sickest patients and the many shades of humanity carry me through a pandemic with hope and faith.