When we?re stripped of our resources, our science, and our egos, there?s only one thing left
We are in a bizarre state of limbo within this crisis. We feel?hopelessly behind, yet still, attempt courageous efforts to be preemptive. Looking down the barrel of coronavirus, my medical residency program had a?fantasy of control. We hoped we might identify?which services were essential?and which were not, staff physicians appropriately, and stagger work hours to minimize exposures and allow some to be available for backup when others inevitably fell victim to either quarantine or the virus.
Imagine our dismay when we, overnight, lost five residents to quarantine. Imagine how our morale tanked when we realized we could not be there for one another in person, and when the only way we could communicate was via text message because there simply weren?t enough of us to cover all the shifts. We suddenly felt we were no longer a team but now just individuals ? numbers waiting to fall ? who were, more or less, on our own.
These days, I feel a sort of odd belonging in the hospital. Here, I?ve had the privilege of seeing the best and the worst of humanity. For every physician willing to risk their life to be on the front lines, I?ve heard another say, ?I didn?t sign up for this.? Resentments escalate quickly as we blame our departments for not providing enough protection, some blaming the government for a lack of guidance, and all of us judging each other for how we?ve chosen to respond, or not respond. Those who are choosing to distance are shamed for being selfish, and those who are working overtime are shamed for being ?martyrs.?
We learn how to deliver bad news like letters we didn?t write, and to wash our hands frequently.
Complicating our response is our career full of trauma. The responsibility over life and the potential for risking our own trigger memories of losing prior patients. 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 to wash our hands frequently. And when a crisis like this hits, 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, an infectious disease fellow, said she?s never felt more burnt out. I haven?t slept in more than three-hour increments for the past week. I go to the grocery store worried I might carry the virus and expose innocent people, and leave after buying groceries I don?t have time to cook.
There is a 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 patients whose heavy hearts and fatigue weigh down their expressionless faces, I?m humbled by those who still have the strength for eye contact. The medicine executive who listens to my concerns and does what he can for patient safety. The ICU resident who looks up from her hands, chapped and chemical-burned from repeated sanitizing, and apologizes for not being able to help me find a bed for my patient. All their beds are full, she says. It?s not your fault, I say. And then we wish each other luck because we both know we need it.
I think of Antoine de Saint-Exup?ry?s words ? 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 2:00 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 she made the decision to not undergo 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 as I try to place her IV and makes me feel better about myself. ?You?re not going to try. You?re just going to do it,? she says. After an hour of attempts, failures, and ? finally ? a few victories, 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.