I Am Scared
I often take little bits of things given to me by people I love to work to brighten my station and to remind me that, come what may, I am loved.
As I type this, I have dusted off innumerable ginger snaps dipped in milk, said glass of milk (maybe two), two scoops of Stellar Coffee Moo’s ice cream, a modest serving of spaghetti, a couple of pieces of garlic toast, and half a dozen dates—since I started cooking supper at eight o’clock tonight. It is now two a.m. I’m going to weigh 300 pounds before this pandemic is behind us. At least I started the day today with a beautiful mixed greens salad and sweet potato wedges.
Until a couple of days ago, I didn’t think I was anxious, but tonight’s mini-binge and the box of Cocoa Pebbles that seems to have evaporated say otherwise. I usually don’t keep anything along the lines of box cereal or ginger snaps in the house, and the Stellar Coffee was the hunny’s way of trying to bring a smile to my face. The last couple of weeks, though, as I thought about buying foods that would allow us not to have to go back to the grocery for a couple of weeks, I might have made some unwise decisions. “Cereal doesn’t go bad quickly. It’s easy to stock up on and simple for the hunny to prepare,” I told myself. I miscalculated my complete inability to exercise self control under stress, and Cocoa Pebbles doesn’t ruin if you finish the box within 60 hours. I can’t even blame the hunny. He doesn’t eat them.
I can’t remember the last time my stomach wasn’t knotted. I’ve watched this saga unfold for over two months now, and this whole COVID-19 thing is wearing on me a little bit. See, my day job, the one that pays the bills, is as an emergency department physician. I have studied the patterns and followed the numbers. As a rule, knowledge allows me to feel more prepared, more in control, so I’ve hoarded it instead of toilet paper. Knowledge about this virus, though, has been limited except for the statistics of its impact, the stories of its devastation.
The Atlantic released an article about how Italy is having to ration its ventilators, those life-saving machines that breathe for a patient when their own respirations aren’t effective enough, how physicians there are having to choose who lives and who dies. In it, they linked an Italian document about the guidelines for triaging which patients should receive a ventilator when there are more critical patients than there are machines to save them. (I have since learned that this is “only” in a few areas and hospitals of Italy, and that in most areas they are, so far, keeping up with demand.) Heart racing, I clicked on the link in the article. It was in Italian. My neighbors, though, lived in Italy for decades and are both fluent, so I walked across the street. (This was before I felt social distancing completely necessary as we had not had any cases in our area, and I had not been to work for days. It was long before anyone else was even thinking of distancing.) They were more than happy to translate it for me and gave me the quick and dirty right then. The next day I had the full translation on my porch:
“It may be necessary to place an age limit on entry into intensive care. It is not a question of making merely valuable choices, but of reserving resources that could be scarce to those who have the greatest chance of survival first and secondly to those who can have more years of life saved, with a view to maximizing the benefits for the most number of persons.”
I have a recurring nightmare in which I am in a strange ER and sick patients are pouring in. I can’t find any of the equipment I need, or the department doesn’t have what we need. Alarms are ringing all around me. The nurses are disappearing, leaving me alone, and it all spins out of control, whirling with increasing speed, a tornado with me at its center. I usually wake up at about this point and spend the rest of the night running through the list of patients I’ve seen over the last 20 years about whom I still worry and the list of families who sleep on any given night with a piece of their heart missing because I was unable to save it. I carry them all with me, and at night they come to visit in my thoughts.
I’m not afraid of the hard work to come. Hard work has never been anything but a friend to me. I’m afraid of the heart work to come. In the coming weeks, I won’t be able to save them all. In truth, I never can, but in medicine, we are not accustomed to seeing a patient who needs a ventilator but for whom one is unavailable. We are not accustomed to being acutely aware of our mortality and the disease we may take home to our loved ones as we care for patients who might carry an infection that has a mortality rate we can’t even calculate because we don’t have enough data. We are not accustomed to having to look up patterns for homemade masks because a very real possibility of running out of the official manufactured ones looms over our heads. We are not accustomed to not having information, medicines, procedures, or plans to combat illness. We know, though, that we don’t have the types of medicines we need because no medicine really seems to make a dent in this illness when it chooses to dig its claws into an individual. We have no offensive strategy in the hospital. There, all we have is defense. All we can do is “supportive therapy,” give them oxygen when their levels are low, and breathe for them when they can’t breathe for themselves. Breathing for them requires ventilators and nurses and respiratory therapists, though, and those are all going to be in short supply. We still don’t even have enough tests to know whether we’re treating COVID-19 or something else altogether, to know exactly who to quarantine.
Reportedly, some larger centers in cities have made respiratory wards of their parking garages. THEIR PARKING GARAGES. I have no idea how true that is, but it comes from sources I consider reliable and level headed. Even if it is accurate, I’m not sure who they think will man those sites. Most facilities I know can’t even staff their usual units, and undoubtedly staff numbers will be lower than usual as staff members become ill and are unable to work. I’ve already heard of multiple hospitals issuing declarations prohibiting their staff from discussing conditions on social media. Not only will we be overworked, some of us will be muzzled. Too bad the muzzles couldn’t include an N95.
My area is still in the earliest stages of this contagion. When I worked a couple of nights ago, our numbers were lower than usual. What patients we did see talked about how they didn’t want to come in because they were “afraid of the virus.” I couldn’t help but think it was the calm before the storm, and that kept my nerves on edge. When I’m fighting, it’s easier to stay in the here and now, but I feel like the fighter in the locker room preparing. I’m bouncing from one foot to the other and shadow boxing. Instead of a beautiful satin robe embroidered with my fight name, though, I am in tattered scrubs, and my gloves are scuffed, dirty relics from the gym’s communal stash. My manager keeps telling me how this fight will be short and I’ll be fine, but I’ve seen the shadow of the opponent while the manager has been in his office counting the dollars the fight might cost him. My heart is racing, my stomach is in knots, and a I am scared.
Our offense against this disease is not fought in the hospital. Our offense is fought in our homes, out of the street. Our offense is taking away this virus’s path of travel, its host. By staying home and away from people who might not even suspect they’re infected, we give this foe nowhere to go, and we slow it down. By slowing it down, we give our medical system a chance to keep up with the numbers, and we build our immunity slowly. If our offense fails to hold the line, our defense will crumble.
My heart is racing, my stomach is in knots, and I am scared. Regardless, tomorrow night I will go to work, and I will stand to defend you against this invisible foe. Please stay home and give me a fighting chance.
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