Waking up from a nightmare

I've been having frequent nightmares, since this all began. I've heard I'm not alone. The common themes in mine are loss, and being lost. Just this past week I was on an overnight road trip to nowhere, in the driver's seat of a car I didn't know how to drive. Family members got sick. Patient's passed. Michael -who in the true world has barely left my side- was with me no longer. From these alternate and inferior faux realities I awaken in my dark city apartment breathing rapidly; to gain composure I sit on the side of my bed, planting my feet into the actual, cool ground. 

As is a dreams tendency, shortly after awakening the details of these parallel lands already start to disintegrate. What's left over is how these nightmares made me feel: scared, anxious, unsafe. I'm glad to wake up.

This past week I've been off, but last week at work I led a team which consisted of a melting pot of providers: interns from other departments, physician assistants from other states, and the youngest of MDs who had shed their medical student skins just the week prior, graduating early to assist on the front line.

On my last shift on service, this crew and I walked down a hallway and marveled at a string of empty patient rooms. Doors wide open, lights off, beds empty. Like a collective conscious we processed the strangeness of the sight: over the previous month our public hospital had repurposed unit after unit, room after room, to accommodate a swelling number of patients. As dramatically as the census crescendoed, as last week progressed the plateau in the number of patients was palpable, and on my last day these abandoned rooms, like clam-less shells or abandoned Incan cities, represented the statistics our hospital system, city, and state were reporting: coronavirus admissions had finally slowed.

But something else struck me, walking down that hallway; a thought that followed me home from work that day, and has stayed with me since. Like an Instagram filter that blurs a photo's edges... like my nightmares shortly after I wake up... those weeks -those fever pitch weeks of late March and early April- were already beginning to feel not just like a memory, but a dissolving dream. 

As I process the out of body experience of what recently transpired -and of course is still unfolding- there are some lessons I do not want to forget. As a reminder for my future self, I've decided to jot them down. 

I have never been so present, so undistracted and un-rushed, at my patients' bedsides. With no competing priorities -research, meetings, after work obligations, and even my cell phone, which pre-PPE was accessible in my pocket- my morning rounds unfurl into the afternoon. Spending longer at the bedside -and surprisingly without the aid of stethoscopes, nor as many labs and imaging studies- I see my patients as clearly as I ever have. 

I have never relied so heavily on my ability to comfort the sick in front of me. With no antibiotics or treatments, keeping a patient calm, quelling some anxiety, really feels like an integral element of providing supportive care.

I have never had to serve as such a bridge between my patients and their families. Unable to be at their loved ones' sides themselves, through daily phone calls, often via a phone translator service, I spent my afternoons patiently updating petrified wives and children. I am actually Ms. Li's sister, the Mandarin interpreter translated one afternoon. Ms. Li, the patient's wife, is too scared to talk directly on the phone. But she is right next to me.

These connections have affected me profoundly. Knowing my role in this web of sorrow, this entanglement of uncertainty, is in part what gets me through.

Shifting to the care team. Amidst the fast pace and stress of hospital life, the relationships between primary teams and consultants, between physicians with a common goal but uncommon expertise, can become a little heated. I've been touched by how physicians, previously on all different career paths and daily schedules, have come together to care for our patients with bravery and gentleness. When this is all over and our paths diverge again, hopefully this shared experience will still bind us.

Outside of work and outside, I've learned some things too. I've reaffirmed that New York City, with its landscape and people, its sounds and sights, is the most special of cities. As the oblivious pink cherry trees blossomed and the first migrant birds settled in Central Park, friends and I swap photos of colorful spring flowers. The lack of crowds, traffic, and the empty store windows make the magnificent architecture, moldings, and facades stand out.  

Don’t get me wrong: almost every day, I review the charts of patients I’ve recently cared for; I am in disbelief and heartbroken to see how many have taken turns for the worse. These patients and their families, certainly, remain seared into my memory. 

I know many have faced tragedy and trauma that they'll never be able to completely wake up from. But as time passes, I know what will most stick with me, with us, is how this experience made us feel. I look forward to taking some select lessons with me as well. I look forward to better dreams ahead. 

I still can't smell them, but beauty on the UES