On my work desk there sits a Ziploc bag of colorful odds and ends I’ve collected during each shift. Vibrantly tinted medicine vial caps, translucent plastic fluid tubing stoppers, soft violet covers that pop off the lancets I use to check a fingerstick blood sugar. I started collecting these a few months ago. At first, I wasn’t sure why I found myself dropping these little tokens in my pocket instead of in the trash can. Perhaps because it feels wasteful, perhaps because I need something to hold onto, something physical to remind myself of what was happening. Of the patients I care for. In the midst of the pandemic, everything feels so surreal.
As time goes on, things seem to set into a routine, both within the hospital and outside of it. What would have been unbelievable last year has normalized, if that is even a word to use at this time. In a way, I want a reminder of the day-to-day at work, since time seems to have taken on a different nature. The days flow in a continuous way, difficult to separate. It feels like both the survivors and the fallen of the pandemic are being forgotten without any collective recognition of the tremendous loss and suffering. Outside of the hospital, life seems to be returning to something like it was before, albeit with differences. People sit at tables on the street at restaurants and coffee shops, chatting and enjoying the warm weather. There are lake days and shopping trips and plans once more. Yet within the walls of the hospital, the struggle against COVID-19 continues with no end in sight. EDs, ICUs, and designated isolation floors alike continue to fill with patients who are fighting for their lives. Families suffer with the knowledge that their loved one may never make it home and they cannot be at their bedside to say goodbye. Health care workers are exhausted as they continue to face what seems like a Sisyphean task.
One patient in particular has troubled my thoughts lately. He was hospitalized for COVID-19 and, after weeks of treatment, was not improving. The expression of absolute resignation and detachment on his face still haunts me. He didn’t interact nor speak much, and had an atmosphere of sadness and hopelessness about him. It was as though he knew he might not leave the hospital alive. Several times, when I paused by his glass window, I noticed a single tear streaming down his cheek. Anguish isn’t always physical pain.
For both the patient and the health care worker, the uncertainty and large number of unknowns about COVID-19 are troubling. How do we carry on, day after day, facing a disease we know so little about? I remain hopeful that in time we will have immunizations and a definitive treatment, but what about right now? What about the patients who are on ventilators for weeks without improvement? The young and the old, the previously healthy and the chronically ill? The mothers, fathers, wives, husbands, sons, daughters, grandparents, and friends? These are real people who are succumbing to the illness and are having the worst experience of their lives. The IV pumps and ventilators and medication drips are connected to human beings. It is easy to look at statistics and start to see people as numbers, especially when faced with critical illness and suffering each shift. Yet I have to remind myself that though COVID-19 has not affected my loved ones or myself yet (by the grace of God), any one of us could succumb.
During times of crisis, rituals can bring comfort. I wear headbands made by friends that have buttons sewn into them to hold mask straps. I wear my favorite brightly patterned socks as a sort of good luck charm. And now, I’ve added the ritual of dropping vial caps into my pocket.
Even the donning and doffing of PPE started to feel like a comforting ritual. Though often annoying and time consuming, it is my protection against the virus and something I do before and after I walk into a patient’s room. Shrouded in a plastic gown and an N95 mask and cap and face shield, I probably look impersonal and foreign to my patients. All they see of my face are my eyes between the moments that my breath fogs my glasses. I try to make up for it through warmth and gentleness. I walk in the room and tell them that I’m smiling as I greet them and say, “I wish we were meeting in different circumstances.”
Some shifts, I take comfort in the privacy that my mask and face shield allow. Those shifts that are harder than usual, like when I have elderly, frail patients arrive at the ED from nursing homes, critically ill from COVID-19. Their confusion and anxiety and loneliness are difficult to watch. Those that stand the poorest chance of survival bring the most heartache, and I wish it were possible for loved ones to be there to comfort them. When patients ask if they are safe here, or if they are going to die from the virus, or beg for me to stay in their room a little longer and hold their hand, I am grateful for my mask and protective glasses and face shield to hide my tears. I’ve learned that it’s OK to cry in your N95.
Illustration by April Brust