We’re doing a family walk with the dog on Saturday, my first morning free after five days of doctoring in the COVID-19 era. I’m orbiting outside the family conversation, my hands balled inside my mittens. The sun burns out the remnants of my feelings. The only thing I connect with is a dead tree trunk, sculpted by wind and snow and rain and sun so that it has a new life as a thing of beauty.
Later I walk alone on a rail trail trying to inhale to the top of the trees and exhale through the bottom of the roots but my breath keeps getting stuck on broken branches. Instead I think of the trees and the mountains. The rocks have surely seen worse; each fragment must be cocooned in layers of earthly horrors. And the trees. Their great grandmothers were plowed down to make room for a railroad. Their grandmothers lived and breathed railroad soot but lived to create their mothers who witnessed the paving over of the train bed. The current trees are doing just fine, thriving off of carbon dioxide from bikers and runners. The earth keeps going.
I keep going. My body and my mind have been through much worse.
We keep going. Just last month we used to joke about the plastic waste from our abundant PPE*. Now our masks and gowns are being held in Central Supply until we request what we need. So last Thursday on rounds we opened the PPE carts to find them empty of surgical masks with face shields. With true American grit and ingenuity we improvised by using plain masks with goggles, wiping the goggles clean with heavy duty hospital wipes after every isolation patient. By the end of the day the chemicals on my goggles made my eyes burn. This is how it is now, we keep on going and work with what we have.
As I walk the mountains on my left just a mile or two away look suspiciously like a COVID-19 curve, the one we’re racing to flatten, except there’s no downslope. To my right the shadow of distant hills continues the curve and disappears into the trees. My heart pounds. Every night at 1:30 I wake up from COVID-19-themed dreams. Masks and patients, numbers and graphs and changing protocols tangle my attention, eventually choking my ability to think at all until I fall back into a fitful sleep.
I walk to heal myself. The earth is carrying on with spring as usual. Green shoots poke through the brown dirt and the spring peepers sing right on time. A stand of trees across a field overflows with the cacophony of red-winged blackbirds coming home to roost. Next to me a bony young birch stretches away from the path. On it sits a big-bellied mama robin, her head cocked to the blackbirds across the field. Birds must have ears- what a curse it would be if songbirds had no ears- but I have never noticed them before. There is so much in the world that I never knew.
Sunday is cold but the sun is warming; it’s a sun meant for spring, a hopeful sun. I run for miles trying to push through my feelings as successfully as a propeller plane struggling to break the sound barrier. Occasionally I pass other runners, mostly college students in pairs. As we pass, our exhaled puffs of breath mingle and we inspire these mixed-up puffs with our big runner-lung tidal volumes.
I take a detour up my favorite hill, one with sweeping views of the mountains on three sides of us. As I approach the top I see what looks to be a swarm of butterflies flying low to the ground, but here in New England we don’t have butterflies in March. I look more closely- they could be birds, but I can’t think what birds could be that tawny color. It isn’t until I stop that I figure it out: it is a pile of dead leaves caught in a stiff breeze. The leaf vortex picks up speed and height and plows backwards, agitating more and more leaves as it travels. They’re swirling tight at the bottom and loose and wide towards the top, a fearsome maelstrom of decaying matter taller than the treetops. I zip my jacket up over my face and it does nothing to keep the sharp wind out.
Back on the path, no one says hi to me. We smile with our mouths closed. I pass people with a wide berth. Two elderly women recognize each other and stop to talk. One stands to my left, in the dirt on the edge of the path. The other stands eight feet away on my right, on the other edge of the path and they talk about FaceTiming with their grandchildren. Another pair of women walks together separately on either side of the path. I pass them down the middle, four feet from each of them, cringing and holding my breath until I no longer hear their voices.
It’s like this with my patients, too, even if they don’t have COVID-19. I used to travel from room to room with a pack of students, interns and residents. Now if we need to use PPE, we round in the patient’s room with only a skeleton crew. Later on, to avoid using more PPE, we use the phone to check in on patients or talk from the door. Last week a mom lifted her baby’s onesie and held him up to the window so I could assess his breathing. He kicked his legs, shook his arms and smiled. The baby was breathing comfortably and I deemed him safe for discharge with a thumbs up through the glass.
Another baby, no stranger to illness, was sick again and his mom sick with worry. My senior resident sent the intern into the room to talk to the mother. “I told him that this would be a good use of PPE, for him to go in and talk to her in person. I hope that was okay.”
I found the intern and went in with him. Between us we used two gowns, two pairs of gloves, two precious surgical masks. We examined the baby who was breathing sixty times a minute, sucking in the line between his rib cage and his abdomen. I swaddled him, handed him to his mom and he immediately slowed his breathing. I put my blue gloved hand on his mother’s shoulder and told her what a good mom she was. We both teared up. This is what PPE is worth, a touch, words, eye contact. For those who survive- patients, doctors, nurses, and the myriad people at the heart of this pandemic- this is what will be lost along the way.
*PPE = Personal protective equipment, which includes masks, face shields, gowns, gloves. We wear PPE to minimize our exposure to contagious viruses and bacteria.