April 2020 was to be a month of personal milestones. I would be traveling to Mexico with sixty closest friends and family to marry the woman of my dreams. Twelve days later, I would celebrate my thirtieth birthday. Suffice it to say, I was looking forward to April with the excited anticipation of a child on Christmas Eve. But that was before COVID. Before all eyes were focused on the novel virus that was devastating the Hubei Province in China. Before a young ophthalmologist risked his life to expose the truth and ultimately succumbed to the disease himself. My first inkling that COVID would affect my life came in early March. After a two-week stint of night shifts in the pediatric emergency room, I was finally able to catch up on world happenings. I read first-hand accounts from physicians in Lombardy, Italy depicting scenes in which hospitals were running out of ventilators, patients were dying alone in hallways, and physicians themselves were becoming patients. The more I read, the more I began to fear. I grew afraid of what the virus would mean for the world, but also of what it would mean for me. I knew then, two weeks before any stay-at-home order was enacted in the US, that hosting a wedding for 60 guests would be unconscionable. And I knew then that my time on the frontlines was imminent. My fiancée, Rosa (also a physician), had dedicated countless hours in preparation of our wedding. We had put a hefty sum of money into nonrefundable deposits. Our guests had all booked flights, reserved hotel rooms, and taken vacation days to be there with us on our special day. How could I explain to everyone that it was too risky to go forth as planned (especially when, just a few days earlier, our president said we were almost at “zero” cases)? And more importantly, how could I tell my bride-to-be, whom I love more than anything in this world, that we would have to postpone our most special day without it seeming like I was getting cold feet? But these conversations seemed easy compared to the prospect of having to man the frontlines as this deadly virus came barreling down … As I write this in early May, I have just completed a month-long stint as the medicine admitting resident, our hospital’s liaison between the ER and the inpatient medicine service. This means that during my 12-hour shift, I saw virtually every patient that was admitted for COVID. I was fortunate never to worry about PPE; every time I stepped into the ER, I was appropriately garbed with an N95, a face shield, a gown, and gloves. But no matter how many layers of protection I wore, nothing would assuage the fear that coursed through me each time I entered the room of a “rule-out COVID” patient. Just three nights in, I broke down. I called Rosa on the phone, crying. I told her that I was ashamed, that I was failing. I was scared to go into every patient’s room, to touch them, even to speak to them. This was the very part of medicine that usually gave me the most fulfillment, the human connection, and I was too afraid to provide it. I don’t remember exactly when things changed, when I finally stopped being afraid. But I am so thankful the fear abated because I quickly realized that empathy would be the most powerful tool I possessed in the time of COVID. Over the ensuing weeks, I became painfully aware of the futility of most of our therapeutic interventions; whether a patient got antivirals, antibiotics, or anti-inflammatories, nothing we did seemed to make a difference. And even the endless stream of “EARLY RESPONSE TEAM” and “CODE BLUE” overhead pages became a reminder of that futility. Normally, I would approach an ERT with a systematic plan about how I would address a patient’s rapid heart rate, low blood oxygen level, or falling blood pressure. I would arrive, adrenaline coursing through me, ready to play the hero. But now I was resigned to a slow-motion, alternate reality version: … another ERT … as I cautiously breached the threshold of the patient’s room, the bedside monitor alerting me that her oxygen saturation was dangerously low. PE was already ruled out, she was maxed out on non-invasive ventilation, what next? All I could do was reach for her hand, squeeze it empathetically and whisper “I think it is time for the breathing machine.” When she looked back at me, eyes wide with fear, head nodding slowly, I calmly called out to the nurse: “Page anesthesia, have respiratory bring the vent, get the drips ready.” I felt her hand relax in mine as she knew there would at last be respite from her days-long struggle for air. I cannot even guess how many times I had to page anesthesia or how many hands I held as I watched the oxygen saturation tick below 80%. But what I know for sure is that the ability to provide comfort to my patients in these final moments of distress is what allowed me to keep going. It allowed me to feel human in these inhumane times, a tiny relief from the chaos abound. On April 3, three days before I would admit my first COVID patient, Rosa and I met her sister Victoria and her brother-in-law Jack in Liberty State Park, me in a cobalt-blue suit and her in a beautiful white dress. With her parents watching from a safe distance and my parents along with dozens of friends and family tuning in via Zoom, Victoria pronounced us husband-and-wife. The rain held off just long enough to allow for the picturesque backdrop of lower Manhattan to come into view. While our dream wedding in Mexico would have to wait, we declared our love and commitment for one another amid this global pandemic, reminding ourselves and all that bore witness that life will go on. Toby Terwilliger is an internal medicine-pediatric resident. Source
