The sirens wail as the ambulance approaches, bouncing off New York City skyscrapers and empty storefronts. They swirl around one building, sweeping up old paint chips and dust from centuries-old stairs. Inside on the third floor, a family paces around in panic. Their matriarch fights for air. The youngest holds her hand and softly sings her favorite song in her ear. She tries to stay calm, focusing on the walls donned with the colors of their Dominican culture. But she can’t breathe. The EMTs enter the building. They hear the scrambling behind the door and knock authoritatively. They tell the family on the other side not to open, and they ask a list of questions through the door, since the pandemic has put their own health at risk. After hearing that their matriarch had been struggling with a fever and cough for a week, the EMTs open the door and move swiftly toward the patient. Seven individuals have been living in this quaint, small apartment for years. The place has been crowded with love, they liked to say. The oximeter on her finger reads 85 percent, a dangerously low oxygen level. They place a mask on her face, and oxygen begins to flow into her lungs from a rusty tank on wheels. It’s time to leave for the hospital. The family is told that none of them can accompany their matriarch inside the hospital. Her daughter runs to grab her favorite blanket and a family picture to carry with her, so she will never feel alone. This is the seventh call of the day for the EMTs, three friends bound together by the horror they’ve seen – pulseless bodies, screaming relatives, barren streets. They give the family a few minutes to mourn, knowing this will likely be their last time all together. The matriarch asks everyone to hold hands, and leads a breathless prayer: “Padre Nuestro.” Tears run down her face as the prayer ends, and she signals she is ready. The EMTs gingerly bring her down the stairs toward the ambulance, waiting out front. The generations stand together on the sidewalk, holding each other tightly, waving as the sirens wail once again, and their matriarch disappears into the New York City evening. They did what they were told. They washed their hands; they covered their faces with scarves; they stopped the ritual of morning hugs and nightly kisses that bound their family together. But the matriarch’s son worked at the local grocery store where there were no masks, no gloves available from his boss. He found his own. He couldn’t afford to quit, and felt nervous with each new customer potentially carrying the virus. The matriarch’s daughter sat on crowded subways early in the mornings, seeing familiar faces of color on the daily commute to keep the city running. She cleaned the floors of one of the city’s public hospitals for many years. She kept her distance from the family as much as she could, knowing she had probably been exposed no matter how careful she tried to be. Guilt crept up on them both, and they feared they could be next. But the nation told them they were essential. The days after the matriarch’s departure were marked by hours waiting by the phone. The matriarch’s daughter would park in front of the hospital, reciting “Padre Nuestro” and asking for God’s grace, to bring her mother home safely and whole. As the daughter fell asleep one night, the phone rang. The matriarch’s doctor explained they had to intubate because she could no longer breathe on her own. The doctor assured her daughter that they were able to provide comfort in her final moments. As a black infectious disease physician working at the height of the pandemic, I heard this story play out over and over again as our hospitals filled with patients. Entire families, mostly black and Latinx, from the surrounding working-class, Dominican neighborhood in Upper Manhattan have fallen to COVID-19. The essential workers, forced to venture out of their homes to keep the country running, lacked the basic protections against this deadly new virus. The trauma of watching loved ones struggle to breathe, of knowing they died without a familiar face present, is compounded by the intergenerational trauma of racial and socioeconomic inequality. We cannot wait until the aftermath of the COVID-19 pandemic to address health care disparities for communities of color and the working class. The families of those we lost to COVID-19 need the nation now. The health of a society is measured by how it treats its most vulnerable. The pandemic has brought together the issues of death and disparities for us physicians in New York City. When there are no vaccines, no treatments, how do you ensure your patient dies with dignity? How do you summon radical empathy as the bodies pile up around you? How do you advocate for those closest to the pain? How do you begin to not just acknowledge the pervasive health disparities that exist in care but finally break the cycle? All health care providers can insist on a health care system free of trauma, institutional bias and racism, segregated care, and unequal access. The morning the matriarch passed away, her family recited “Padre Nuestro” through the phone. They then spent the rest of the day together, eating leftover mofongo and fresh mangoes, remembering and honoring a life well lived. The next morning, a 9-1-1 call was placed from the matriarch’s home. “9-1-1 Emergency, can I help you?” the dispatcher asked. Through pursed lips, the matriarch’s son said, “We can’t breathe.” Ofole Mgbako is an infectious disease physician. Source
