It seems worthwhile to jot down the current rituals.
Later, if we are all successful in climbing out of this, it may be of interest and importance. The ad hoc traditions, starting with applause for doctors and other front-line workers every night at 7 o’clock. Red lights flood the Empire State Building. “Sonya, they are clapping for Dad,” my wife, Allie, calls out. Sonya, our six-year-old, runs up to the window and, imitating the cheers she’s heard on TV, joins the communal “Woohoo!” You can base your daily assessment of how dire things are on the intensity of those cheers: the scarier the statistics, the louder the applause.
You can also base it on the frequency with which you hear ambulance sirens. Over the past month we New Yorkers have heard them day and night. From the building across the street people in hazmat suits are carrying out the next ICU patient. And the applause intensifies accordingly, a salute to this team in particular. Our neighbors from downstairs come out on their balcony. A middle-aged couple, they are here every night half an hour before the cheers begin, enjoying the sunset with a glass of wine, holding each other. As they raise their heads, they see us at our window and wave to us. We wave back. These are the moments of peace and joy.
The scarier the statistics, the louder the applause.
In the hospital we also have our rituals. Every time a patient comes off the ventilator bells play on the PA system; every time someone is discharged home, they play the Beatles song “Here Comes the Sun.” It reminds me of what I saw when Allie and I were backpacking in northern Siberia ten years ago, where there is a custom to paint houses in neon colors, a human response to the lack of light. I am moved by all of these gestures, even if they serve as yet another reminder of what we are all going through. People show their true colors, and the colors are wonderful, like those neon façades in the land of six-month polar darkness. They show their colors by supporting the “Feed the Doctor” program, delivering free meals to hospital workers from New York City restaurants. They show them by sending us home-sewn masks and plastic shields, produced on their 3D printers.
You can never have too much PPE, which, of course, has its own set of rituals. Before going down into the clinic, I change into my “Covid scrubs,” put on my mask, clinic shoes, face shield. I take a few tissues with me, so I don’t touch the doorknobs with my bare hands. A small bottle of hand sanitizer is always in my pocket. This again reminds me of another part of the world: over the past ten years I have done a lot of medical work in different parts of sub-Saharan Africa. There you are always making sure to avoid contaminated water. You close your lips as tightly as you can when you take a shower; you brush your teeth using bottled water only. You remember to take your malarial prophylaxis in the morning. Within several weeks of being there, all of this becomes second nature. Here the precautions feel just as ritualized but, unlike with the water in Africa, I can’t get used to this even though it’s been nearly two months. It’s a conscious effort and a psychological struggle every time.Embed from Getty Images
As I drive to the hospital, signs on I-495 spell out simple instructions: “Stay Home Save Lives,” “Cover Your Face in Public,” “Flatten the Curve.” And the motto: “We are NY Strong.” In an age where people are drowned by the daily flood of information from the outside world, we are suddenly isolated from everyone and everything. We don’t venture out, and have no perspective outside our four walls. We don’t know what is going on outside; we certainly don’t know what the existential threat looks like unless we experience it firsthand. In such a situation, everyone’s time and space become synchronized.
And as distance becomes an abstraction like everything else, I can have the same Zoom party with my next-door neighbors as with my friends who live halfway around the world. The discourse is simplified; there is only one topic to keep track of – people from all walks of life are discussing the same thing. Those who are alive twenty or forty years from now will have this as their common point of reference, just as my friends and I who grew up in late-Soviet Russia have memories of Chernobyl and perestroika.
It’s important to jot it all down, even as disjointed diary entries, but it’s not easy to find the energy to do it. There are too many other rituals these days, not the new ones people have made up to “rage against the dying of the light,” but the ones that permeate every hospital setting: the “codes” and “rapid responses.” These are also announced over loudspeakers. It means someone’s oxygen saturation is plummeting; someone’s blood pressure becomes unstable; someone’s life is slipping away in minutes. The twenty-five-year-old is getting intubated. It’s not just the old and the sick. (And what if it were?) People’s lungs, hearts, kidneys are giving out. As the media fixate on the numbers of ventilators needed and numbers available, the message gets muddled: A discouragingly small number of coronavirus patients who go on ventilators ever come off them. Even among those who do, a person who has spent two weeks on a vent may not ever go back to being healthy again.
A month and a half ago the first of my patients tested positive for Covid-19. Her husband got infected, then she did. A week later she was still without symptoms; the husband was already dead. One of my former fellows has been in practice with two other physicians, husband and wife. Both of them got it. Now the wife is still fighting for her life on a ventilator while the husband has passed on. A friend who works as a pharmacist at another hospital just buried her coworker. He had turned sixty-five and was set to retire at the end of March but decided to postpone his retirement by a couple of weeks to help in the crisis. “What’s a couple of weeks? I can start my retirement a little later . . .” This is the fragility of life now.
Yet, I do believe that it is important for doctors to talk about what they see.
As an American doctor and a Russian-language author, I have always led a dual life. When the pandemic started, I promised myself that my two identities would not get mixed, that I wouldn’t write any “Covid chronicles.” First, there will be enough of these written without my contribution. Second, for me, the pain is too fresh to turn it into art just yet; it somehow feels wrong.
Yet, I do believe that it is important for doctors to talk about what they see. A firsthand witness account is the most important type of information one can have right now. This essay then, is a note to my future self; it is also a plea to those who are far from the epicenter and cannot bring themselves to believe in the reality of what they are being told. This is real, it is here and now. Someday we will be rereading the witness accounts, reminiscing about the rituals, shaking our heads again in disbelief. By then, though, we will only be questioning the veracity of history rather than the grim reality of here and now. I can’t wait for that day to come.