I spent the first surge worried I would kill my husband. I am a doctor and he has bad lungs. He does also have his own exposures, even works in the hospital—spiritual care. Suddenly the grieving were also infectious. Some nights, over the drinks we started to always have, we would wonder out loud which of us was the hero of the story of our lives. The hero is the one who will survive this.
Back then, when one of us had worked in emergency or consulted on the COVID-19 wards, we would sleep in separate rooms. Now we do that work every day, and we don’t always want to be alone. I feel in my body that this grief will be permanent, although the doctors who run my residency program speak only of resilience, when they speak of the pandemic at all. They show a bored sort of disbelief in their trainees’ new and universal disinterest in anything educational. Why become a doctor if you can’t handle all this death? Far from the bedside, the men in charge get stars in their eyes when they describe this historic time. Online, the crowds are less inspired. “Do your job,” say the comments under firsthand accounts of working COVID-19 units in U.S. hospitals.
Hero or not, I am someone who never outgrew a child’s world view, cast centrally in the drama of all human life. Survivors of abuse often get stuck in this place, in the permanent self-centeredness of having a weak sense of self. Raised in a setting of neglect and violence, I carry the loaded diagnosis of complex PTSD. Now that I am also, somehow, a medical doctor, I tend toward stubborn self-importance, and I do not suffer well. My husband, in contrast, as a hospital chaplain, is a certified calming presence, friend to the sick, broken, and alone, a professional beast of burden. Neither disposition, I can tell you now, rises better than the other to this particular moment, though it may be useful to have been traumatized in advance.
Early in the first surge they banned the chaplains from the hospital. This was when we received daily updates on the supply of PPE, with gowns, face shields, and N95s always in the red. It didn’t take long to see the work was untenable. The late-April suicide of ER doctor Lorna Breen inflected our profound collective despair. In makeshift ICUs, patients were dying of unwitnessed self-extubation, dying when their IV bags of blood-pressure bolsters ran out faster than the nurse could change them, the nurse who could safely staff two or three patients but was caring for closer to ten. Even if you could set aside these extraordinary early horrors, you still had to hold the cumulative weight of all those unattended deaths, the phones held up to ventilated faces, the sounds of the cries on the other end, room after room, again and again.
In the summer lull, in our house, nothing got much better. We stopped our daily drinking, at least, and tried to practice self-care. We went for runs, we waited for the pale green shoots of feeling to grow back. We watched the new surges in the Sunbelt and the Midwest, and tried not to remember. In the lead up to the election, parades of trucks would drive through our deep-blue town with banners reading TRUMP 2020, FUCK YOUR FEELINGS. Sure enough, it seemed to be the mantra of the whole country, boldly crossing domains and party lines, shouted out from every crowded restaurant even as the numbers surged up again. 2020, FUCK YOUR WELL-BEING. 2020, FUCK YOUR FUTURE. 2020, FUCK YOUR FAMILY. I had to begin applying for fellowships. It was an awful time to consider a move. “What do you think we should do?” I asked my husband, but he could endorse no hope for anything.
I am in my last year of residency training in neurology. We are supposed to spend our chief year perfecting our bedside exams, mastering the minutiae we need to pass the boards. After a decade of training, we are supposed to finally come into our own. Instead, I find myself dragging through a chaos of white noise and cognitive dissonance, moving weakly through the motions of doing my job. Somehow, despite all we learned in spring, and the global demonstration of the simple effectiveness of strapping paper to your face, here in December I am running a consult service where a third of our patients are positive: COVID-19 encephalitis, COVID-19 strokes, COVID-19 and won’t wake up. We avoid examining them whenever we can, to spare ourselves, mostly, less so to save the PPE needed for an unrevealing coma exam. When the patients come in altered, though, or found down, we have to come in running, in case the cause is an ischemic stroke new enough to reverse. The attendings say, There are no emergencies in a pandemic. They tend to stay in the hall.
A good death, I have been taught, elevates all of humanity. So now I wonder: What is the weight of 302,000 bad ones? How low can humanity go and still stay meaningfully intact? I cannot tell if I am struggling more than my fellow physicians or just struggling more openly. My failure to do well by patients in this setting gives me a deep and unsubtle sense of absolute worthlessness, even if I am doing the best I can. Perhaps I am just quicker to name the limit of what I can bear, as if naming that limit, again and again, can push it out far enough to contain all this. I did, for instance, on a bad night after my husband developed sudden anosmia, call the employee mental health hotline. What you need, they told me, is an SSRI.
What I did a lot in the first surge was listen to a folk cover of an R and B ballad called “The World’s Greatest.” Every day, at least once, in the morning riding in on my bicycle. “I am a marching band, I am the people,” the song says. “I am a helping hand, I am a hero.” I heard it with equal parts aspiration and irony. It struck me as a good song to play at, say, a funeral? And then this evolved into thinking a lot about that funeral, and then I realized the funeral I was thinking of was my own. Sure, I’ve had in my life plenty of what the pros call SI, suicidal ideation. How do you know when to take it seriously? If you have a plan, we decide, my husband and I, lying in bed—just the way I was taught to screen my patients. It is called passive if the thought just pulses, planless, in your head: I wish I were dead, I wish I were dead. But set that bar and the mind starts making plans, just to be provocative. Our last apartment had sturdy wooden beams across the ceiling, but this one is modern, smooth and bare. Step in front of a train, I guess? Yes, my husband says, without much commitment. We live two blocks from the tracks.
Ten years or more ago, I was a writer working on a fiction M.F.A. I took a summer course with an editor, a famous misogynist, who one day got so bored with our whole class he forbade us from reading another word, and demanded we tell stories out loud, extemporaneously. I had spent my whole life being silenced. I was, in that moment, a total blank. “I don’t have any stories,” I said on my turn. “How old are you?” he asked. I was twenty-two, and said so. He called this age “old enough to die.” Later in the class I tried to write about my experience of trauma, particularly sexual assault. “Women,” he said, to me and in front of everyone, “always want to write about rapists. Were you raped?” he asked me. Why did I answer that? “Well,” he said, “I wouldn’t believe it.”
He occurs to me now, in this climate of cruelty, in a plague exacerbated by bizarre and destructive selfishness. Why? Maybe I still wonder if I have earned the right to speak. That man would get #MeToo-ed to death today, if he mattered enough for anyone to bother. He was a warning flare from the sinking ship of toxic masculinity, horribly afraid of irrelevance and death. The bravest act you could commit as an artist, he told us, was to confess (with manly pride, in the gleeful cadence of poetry) the worst things you ever did to anyone. How dumb, how dull, how simple that looks now. How easy to be awful and privileged, and to gloat. What is hard, of course, is to keep showing up, to work without hope as part of a hopeless whole, do work which is unrewarded and bodily and takes time. And try, of course, to sing about it.
I did take something from him to keep, a notion of writing as a psychoanalytic act, which has in it no therapist. In this way I have built whatever muscle lets me keep trying to parse out this garbage year and what it is doing to me, to my husband, to all of us, even as we all get pressed further beneath the wheel. I don’t know if telling these truths matters, but I tell them for my survival. Or perhaps I am lying—wouldn’t that be a twist? For attention, I guess, and for the money we doctors make on fake COVID-19 diagnoses. “It’s okay, nothing matters,” is now a joke we tell at work, as a response to the news or a flood of new consults or a missed meal or an intracerebral hemorrhage.
I see another consult for stroke in a patient with COVID-19. The woman is on a COVID-19 floor, each room equipped with video monitors. She speaks another language, and I can’t imagine how the interpreter housed in my telephone will work over the video screen. So I just go in, full PPE. She is curt, almost, says, “I’m fine, I’m fine.” Even the virus, she says, it isn’t doing anything. And her exam is normal. I am relieved. The stroke, which looks old on CT, can be worked up later, when she is no longer infectious. “Tienes preguntas?” the interpreter asks on my behalf. Then at last she speaks at impassioned length. I get restless in my N95, watch the fog forming on my glasses—a sure sign that the universal isn’t quite my size. The interpreter tells me she is asking a lot of questions but they aren’t about her stroke, they are all about her husband, who is also infected. She says he has been in the ICU for weeks. She says she is not getting any updates. I say to tell her that I am the wrong doctor.
Doctoring is men’s work, although we work to change this. The affect of a good doctor, by which I mean a doctor who is praised and a doctor who is promoted, is still the affect of a man. If you want to be a doctor and still model the acceptance and expression of emotion, you must be unimpeachable in everything else you do, and you can’t lose control, not even a little, not once in public view. So it is at home, at night, that I try to expel enough of this despair to keep showing up. My husband is formally trained in bereavement, and I sometimes wish that he was not. I sometimes wish he could meet my grief in the elliptical way that poets or artists might console each other. It is our work that keeps us both in this trap, always either rational or strictly on the body. We are always just bringing each other food, or holding space or saying, “If I understand you” or “I see that you are suffering.” A pleasant diction that seems to always miss the point.
I used to love being in the hospital. Now I hate this place, with the flat dispassion of a child left too long uncared for, the feeling you feel when you can’t feel anything. Soon, at the hospital, they will line us up for our vaccines, and then we will work, immune, through the long COVID-19 winter. Me first, I’m guessing, and my husband just after. We will find, in time, some way to sort the wreckage, but I don’t believe we will ever recover, those of us who watched this senselessness unfolding, those of us who lost someone we love. There isn’t so far left to go before we both survive this. And I will try to hold on, although the road is dark and I am already so tired. This is my message to anyone who isn’t already in the hospital, in the bed or standing beside it: Just hold on. I will say it to myself, and keep showing up, and playing my song, and see if it gets better.
Anna DeForest is a resident neurologist at Yale New Haven Hospital. Her work has appeared in Unsaid, Alaska Quarterly Review, New England Journal of Medicine, and elsewhere.
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