I tried to read this aloud to my spouse tonight and couldn’t get through it without being overcome with emotion.
Who were you before the virus, before you were this — this list of failing organs run in despair by a repurposed trainee neurologist? Do you have children who smile at the sound of your voice? What was the last thing you were allowed to tell them, before you came alone into the hospital, before the breathing tube, the drug-induced coma?
It is a column by Anna DeForest, M.D., M.F.A. in the New England Journal of Medicine.
This is the day you start to turn. What we suck up from your lungs turns frothy pink and then the frank red of blood. We don’t know if your heart is finally failing or if the virus has destroyed so much tissue that this is necrosis, hemorrhaged in your lungs. There are tests, but no one willing to run them — you are too sick, and you have never cleared the virus. No one would ever want to be what you are now: a hazard, a threat, a frightening object on the edge of death. We try not to touch you. We construct our plans for saving you around staying as far away from you as possible.
I tell your husband about the blood. It’s true that nothing else has changed: your struggling lungs, with help, still take in air, your heart, with help, still brags along. “But she is stable,” he asks, barely a question. Why do I lie? “Yes,” I say, “for now.”
It is an account of the experiences of a front-line health care worker that I believe all Americans should hear.
I strip in the doorway when I get home, stand in the shower too tired to think or cry. I sing “Happy Birthday” twice over every part of my body. At work I can’t eat, at night I can’t sleep. The dreams I have now have only three themes: gasping for breath; wiping things down; somehow, by accident, being touched by somebody. Did you ever wake in those last moments, or in your sedation did you ever dream? I still wake some days with a small beat like a held breath before the truth of this new world hits me. “Be safe,” say the families I call on the phone with updates.
Forgive me if I am extracting too liberally from the column.
The morning you die, I don’t want to be there — like most mornings now, when I rise against my whole will and crawl dejectedly into scrubs. I don’t want to be a plague doctor or a hero on TV. Now on the news, White men hold guns and signs that say “live free or die” to protest the lockdown. I imagine what they will look like dying on vents in ICUs staffed by doctors lacking sleep and proper training, soaked in moral fatigue. I imagine what their wives will sound like on the phone as they cry and say “Do everything.” I wonder if these wives will thank me or tell me to be safe.
You are crashing, they tell me in sign-out on your last morning, on three pressors now, rates all maxed. Maybe sepsis from some new infection, maybe you lost the last legs of your heart. We won’t find out, and I can’t see now how it matters.
Like the horrors of war that we have repeatedly been shielded from, the true horror of our current national experience is far too hidden.
When the code is called out overhead, your code, I shrink and stall, and move through thick air, slowed as in a dream, nurses and other doctors pushing past me, throwing on respirators and face shields and gowns. By the time I get there, the room is full. With my arms at my sides, I watch through the glass. I have never mattered less in my entire life. I watch your feet kick to the rhythm of compressions. They use a machine — the thumper, they call it, a joke, almost, to space us from the horror of it all. Staff in yellow gowns stand around your room, waiting to see if they are called inside. And this is how you die, near no one who ever loved you, a spectacle of futility and fear. Time is called, and someone calls your husband, and it isn’t me. I am not the one who hears him cry out in grief. Forgive me if I am grateful.
Cherish your loved ones. Honor and support our health care workers.
What else is there to say? You are dead, like so many others, and the rest of us are left to live in the absence of any certainty. We can’t go on, and we go on: back to work, back to rounds, back to the next case coming crashing in. It is no use to think about the future, our training, or what happens next. We are all attending now to a historic and global suffering, and learning the limit of the grief our hearts can bear.
This disease is not the sniffles. And the national trauma we are experiencing is not going to magically or easily disappear.
https://www.nejm.org/doi/full/10.1056/NEJMp2016293