Note: The Nocturnists is created primarily as a listening experience. The audio contains emotion, emphasis, and soundscapes that are not easily transcribed. We encourage you to listen to the episode if at all possible. Our transcripts are produced using both speech recognition software and human copy editors, and may not be 100% accurate. Thank you for consulting the audio before quoting in print.

Ashley McMullen

You're listening to The Nocturnists: Black Voices in Healthcare. I'm Ashley McMullen. (THEME MUSIC)

I just did a weekly call with my fam in Houston. We talked a lot about COVID-19. How the cases continue to surge in Texas. When is this shit going to end, y'all? When can I go back and hug my grandparents? How do we ensure a safe plan for my niece and nephews this fall?

There's so much noise. And I'm tired. We asked you this week to share your experience of COVID-19, not only inside the hospital or the clinic, but in all the ways that it's crept into our lives and transformed us. See, pandemics don't just wreak havoc on bodies. They create shockwaves that, sooner or later, touch every corner of our being. Here it is. “Episode Five: Pandemic."

Kimberly Manning

Week One: "Hey, Sakina, this is Kimberly. Hey, girl, um, just checking on you and making sure that you got some hand sanitizer and make sure you go get some toilet paper and paper towels, cuz, uh, girl, this 'rona is rampin' up."

Week two: "Hey Sakina, this is Kimberly. Girl, you know they closed the schools so I'm just checking on you. Making sure you don't need anything, that you're doing okay over there and that your family's okay. Stuff is getting kind of crazy. So hit me up if you need anything."

Week Four: "Hey, uh, Sakina? Hopefully you're doing okay. Here, when you get a minute we got to talk because I need some instruction on what I'm gonna do with this hair."

I have seen my hairstylist every two weeks since 2001. And I am missing the hair salon. You know, in the hair salon, we yuk it up, we kiki, we talk about music, we dance like Beyonce. We laugh together, we celebrate births, we grieve deaths. It's just been a part of my world that is now gone because of the pandemic. And Sakina is really somebody that has been more to me than, I think, I fully appreciated before this pandemic hit. You know, it was Sakina who was with me just hours before I met the love of my life. And it was Sakina who woke up at zero-dark-thirty to do my hair on my wedding day, and who stood with me, just moments before I would walk in on my daddy's arm, to fix my veil on my head. It was Sakina who put her hands on my head one day and looked at me and said, "Girl, you need to take a pregnancy test because your hair feels different, and I know pregnant hair when I feel it." And she was right. And it was Sakina who offered to come to my home to do my hair when my sister died of a sudden cardiac death in 2012, because she knew that getting my hair done would make me feel better. And she was right. Ah, it was Sakina who looked at me one day and said, "Girl, you going gray. And it's just time for you to stop coloring and embrace it." And, because I trust her, that is exactly what I did.

So my every-two-week experience of going to see Sakina has been rudely interrupted by this pandemic. But, like she always does, you know, she avails herself to me in ways that go above and beyond. So I called her up, and I was, like, "Girl, you got to help me," and so we get on FaceTime as she tries to talk me through doing what she does as a professional. And I am woefully, woefully inept at doing so. So we just laugh and laugh. But she said, "You know, really the key is that you just got to own it, whatever the look is." She said, "Why don't you just wear your African head wraps, Kim? You have those."

And I do wear African head wraps on weekends and when I'm around Black people, but it had never occurred to me to wear it in to the hospital. But it also never occurred to me to let my hair go gray or to do a lot of the things Sakina has given me the courage to do. So with the help of Sakina, and YouTube videos, and my bathroom mirror, I mastered a few more ways to tie my African head wraps. I still remember the day that I walked into the resident conference with this multicolored African head wrap that I had gotten from Zimbabwe the summer before. And I had my head held high, my chin up, and I remembered what Sakina told me. Just own it. That's what I did. I leaned into that podium. And without apology, without feeling self conscious, I said, "Hello, everyone. Welcome to Resident Conference." And that was it. I am missing the hair salon.

Patrick McMurray

Right now I'm sitting in my car, getting my mind right before I go in and work this night shift. I've been a nurse for seven years. And, honestly, COVID-19 has completely changed the way I look at the world and the way I nurse. Being a Black man, and being a nurse, is already kind of a interesting combo sometimes. I've always loved nursing, but I was wholly unprepared for the first time that I knew I was going to have to walk into a room where I know somebody was positive for COVID. But what I want people to understand is, it hits, it hits differently for different types of healthcare workers. But with nursing staff—that being RNs and LPNS and CNAs—it's different, because the main factor of our job is that we are there constantly. We are constantly present. So in a thing like COVID, we're spending a lot of time in these rooms where people are positive for COVID, where I see someone who is a couple of years older than me ventilated and sedated and having vasoactive drips going, and having to be turned every so many hours to help them breathe better. We call it proning. And the first time I walked into a room, all I could think was, "I'm twenty-seven. And I've only been a nurse for seven years. But I've got other things I want to do with my career." And I could, honestly, it was one of those, kind of, cliche– your life flashes before your eyes–moments.

And it kind of took me aback and it was almost, almost panic-invoking to know that I'm standing on the threshold of this door. I have this astronaut mask on. It's got a little fan on and I'm, like, “Okay, what if, what if it turns off while I'm in the room? What if, you know, something rips and then I get exposed?” And it's a different type of worry because nurses are not just in rooms, you know, doing passive things. We're actively turning people, bending, pulling, you know, lifting. And there's so much risk that can be involved with what can happen. And I honestly think that after all of this is said and done, whatever that means, that we're going to see a lot of nurses, kind of, move out of these acute roles inside of hospitals.

It's so funny, because in my seven years as a nurse, I spent six, primarily working in critical care areas, my primary background being in cardiovascular ICU. But about a year ago, I said I wanted to step away from the ICU. I did it for six years. I loved it, I enjoyed it, I learned so much. But I really wanted to branch out into new areas of nursing. So in my job, I work in a role where I float to various units that need help. So I can be in the ER one day, I can be on a psych unit another day, I could be in the ICU. But I took a step back and I stopped working ICU.

But during COVID we were all mandated to get retrained back to ICU. And so it wasn't an option of “if”. We got trained specifically so we could support the COVID ICU that had been established. And thankfully, most of my experiences there have been very positive. But it reminded me that as long as I'm, kind of, in this environment, I can, kind of, be pulled anywhere. I can try to set boundaries, but they could be undone if the organization I work for feels they need to. And I don't say this to disparage my, my employer because for the most part they really don't give me much to complain about. But it's terrifying knowing that sometimes we don't have much of a choice. And that if I want to step away, I can't, necessarily, because my job can mandate it. But here I am. We've made it through, no mishaps.

But I'm changing. And I think that I'm getting to the point in my career where I love, I still love taking care of people, I enjoy the act of nursing, but I realize that maybe it's time for me to find employment where that's not my sole job. And that revelation is kind of hard, because clinical nursing is my bread and butter. That's what I'm comfortable with. It's hard to realize that what you're comfortable with may not always be best for you.

Ty Elliott

I arrived to work on a Monday, nothing out of the ordinary until I landed in the ICU. There were these men dressed in this olive green, brownish-colored uniform. They all had names over their left chest, with yellow stitching. They had combat boots, they had guns on their waist. Each prisoner, each patient, had two armed guards at their bedside around the clock. Five o'clock Monday arrived. As I'm doing my PM rounds, I noticed that the patient in bed one was not doing so well.

He began to desaturate intermittently. I said well, “I can't leave the hospital in good faith with this man looking like this. Why don't we go ahead and intubate him.” We intubated the man and things were uneventful. I came back on Tuesday, and learned that he had not done so well overnight. He had really severe ARDS, his blood pressure tanked. I put him on vasopressors we put in a feeding tube. He was being supported very, very aggressively.

Then on Wednesday, I said we should think about having a conversation about goals of care. Typically, we'll have a spouse or a daughter or a son or someone talking for the patient. And this scenario, that did not exist. We did not allow visitors to come to the hospital. But even one step beyond that, I couldn't freely call this prisoner's family, because they're a ward of the state.

So I talked to the guard and they gave me the phone number to the infirmary. So I did that. And the nurse said, "Well sometimes, you know, they have POLST forms." And a POLST form is an acronym. It stands for Physicians Orders for Life-Sustaining Therapy. It's essentially an advanced directive of what to do at the end of life. And the nurse said, "Let me check to see if he has one." As I'm waiting, I see the first box. The first box was checked. And it said, "Do Not Resuscitate. Do not intubate."

I don't know what this man did. It's not my job to litigate. But he's in San Quentin Prison. And he's been there for decades. And he does not want this. These are not his dying wishes. I made a mistake. I left the floor and I went to my office. I cried. After some time I gathered myself. I went back to the floor. I got in touch with the warden, the Chief Medical Officer at San Quentin. They verified and validated the POLST form. They allowed me to then call the patient's father and his father agreed to uphold his wishes.

So I walked into the anteroom and I put on a gown. I exchanged my surgical mask for an N95 mask. I put on a face shield and I put on two sets of gloves. And the guard, the armed guard, did the same thing. And he escorted me into my patient's room. He had to watch me pronounce him dead. This man was dead, but the guard deemed him still a threat? Why did he need to escort me into the room to pronounce my patient dead? Yes, he was a prisoner. But he's my patient. Give him respect and dignity. I've never experienced anything of this gravity.

Kellie Bryant

COVID has changed my life. And I don't know if it will ever be the same. When COVID hit, I went from my nice, cushy, beautiful, state-of-the-art simulation center to doing things I never thought I would do. I wanted to be on the front line—I'm a nurse. You know, I'm a nurse practitioner. I wanted to help. I couldn't just sit home and not play a part during this pandemic. So I was in a place where I was calling patients to tell them they had COVID, I was calling patients to check on them. And what I wasn't prepared for, was it was more than COVID. The phone calls I was making to patients. It wasn't easy to just tell somebody "Yes, you have COVID. Now, just go quarantine yourself." That's where I thought the conversation was gonna go. But instead, I had people telling me, "Well, how can I quarantine? I live in a house with a bunch of people. We live in the same room.” “ I can't quarantine because I rent a room. And now I'm scared to tell my roommates that I have COVID because they will kick me out." I was telling patients who were already sick with stage four cancer that, not only do you have cancer, but now you have COVID.

And the one call I remember, you know, a woman who, you know, I'm saying, "Yes, stay quarantined." "Well how am I going to get food? I usually eat from the bodega downstairs and I don't have family or friends to bring me food. So how am I supposed to eat?" Same person was using a bucket to urinate in her room because she was scared to go to the bathroom and expose her roommates to COVID. Actually, her roommate told her that she had to leave. So all of that, I just didn't have the answers for. Here I am thinking I'm dealing with just delivering bad news. I can't help them to even take care of themselves. They can't even take care of themselves. They don't have the resources to take care of themselves. You know, it's easy for someone with money to quarantine two weeks in their four bedroom house and have their family members drop food off at the door. I just don't know how, you know, what it's going to take.

I just turned to the news. And we broke another record, you know, we're at 66,000 cases in one day, you know. I'm in New York. Yesterday we had finally for the first time since March, no deaths in New York City. And it's like, why are you not following what we've done. You know, follow in our footsteps, all of this quarantine. It worked. You have the recipe. Use it.

Jennifer Berrian

I'm a rising third-year med student, studying for Step during the pandemic. It's funny because, you know, six months ago, Step felt like the biggest thing in my life. And, I mean, don't get me wrong, it still feels pretty huge. I mean, I'm only, um, gosh, I'm four days out. I mean, what's, what's an eight-hour test, compared to a pandemic that doesn't seem to be ending anytime soon and over 130,000 lives lost, you know? What's Step 1, compared to not seeing my family in person for eight months? What's Step 1? What's school, what's studying compared to having received a total of five hugs in the, gosh, four months, now, I've been in quarantine? I was originally scheduled for Step June 4. That got cancelled. I rescheduled for sometime in July. That got pushed. And now I'm scheduled for the 30th. And as haphazard as the scheduling for this exam has been, I feel like my studying in a lot of ways has been the same. In the four months since Corona–or Miss Rona, as I call her, to deal with my, you know, apocalyptic levels of anxiety when it comes toward this thing–in these four months I finished my second year of med school completely online, along with my final exams.

I adopted a cat named Bella. She's a tuxedo cat, feisty li'l thing. (LAUGHS) And she's the only one I'm getting, you know, consistent physical touch from, and bless her soul, you know, she tolerates it. She's my little companion right now. My little love bug. She has the most beautiful black and white coat, with this almost-mask over her eyes, like this black spot on her face. And these beautiful green eyes. Sometimes when I take my study breaks, I'll just kick back in my recliner. And I'll hold her in my lap and give her a scratch on her neck, and I can feel her purring.

Do you know all the things they tell you like, oh, like, “Step studying is going to be hard, so make sure you're meeting up with your friends and you're changing your study locations.” Like, “Go to the local coffee shop, you know, the library, the student, you know, carols and study spaces,” all of the the tips and tricks to survive this period that we were given. Well, I mean, they all become null and void in the middle of a pandemic. There was this cafe I'd go to. I'd get my little spot, spread out on these beautiful marble tables set up, and really comfortable chairs, and I'd spread my books all over it. And they just had the best music. I'm talking neo-soul, R&B, just bumping from five pm when I got off work, and went to that cafe to study to twelve, midnight, when they closed. And I'd catch the last metro, metro train home. Final stretch, studying for Step, feeling nervous, confident, terrified. Above all else, ready to get it over with. Excited, hopeful.

People have been asking me what are my plans post-Step? Originally, you know, it was gonna involve going home, visiting my friends in LA. Now, it involves sleeping, starting my lock journey, because I'm so tired of doing my natural hair. I love it and I hate it at the same time. And I think that's a pretty common sentiment. But yeah, locking my hair, getting some sleep, and going to a sunflower field in North St. Louis right before sunset, the golden hour, as they call it, with my new locks in my head, just beginning my clinical journey.

Lachelle

I started this whole routine when we broke up. I would get up at the same, exact time every morning. I would eat almost the same thing for breakfast every day. I started walking a certain way to work. And when I got home from work every day I would go to the gym. Started buying all these plants, and anything that was a seed I would just put in dirt and watch it grow. I started buying vinyl records and doing, like, little craft things. And it was just me filling up my space and my time with things and experiences so that I wouldn't be sad all the time, you know? So that I wouldn't feel the weight of this loss. I would feel dirt, or, like, aching muscles from working out or, you know, other things, just feel something else. And it was working. I was still grieving, but I was able to focus on other stuff.

And then there was COVID, and my whole routine was just turned upside down. My lab closed. I'm considered a high-risk person because I'm on immunosuppressant medications, so I was exempt from in-person clinical work. I was scared to go outside because I don't want to get COVID. This death that people are dying, this awful suffocating death on a ventilator, alone, is my worst nightmare. It's probably the worst possible way to die.

And then, out of the blue, like, I get this text from like, the poop emoji. I had changed my ex's name in my phone to the poop emoji. And I get this text. And it's, like, "Can I call you?" And I was so pissed off at myself for not being angry that he would have the gall to text me after all this time. And I was irritated with myself when I answered the phone, like, I heard myself going, "Hey, how's it going?" Like nothing had happened, like it was just all good.

And he started in about his dad. His dad had COVID and was very sick and was in the hospital on oxygen. And the doctors were considering intubation. And he was asking me what I thought they should do. And I never heard him like that before, you know. I had known him for almost four years, I guess. And I had never seen him cry. I'd never heard him cry. And his voice was shaking. And I could tell he was scared. And he told me how his dad, like, when he dropped him off at the hospital, said that he was proud of him. And basically said goodbye, you know. And he told him he wanted to die on his own terms. He didn't want somebody to decide when he would die. And so, like, I'm hearing this from my ex, and I am, like, just emotional. So I'm, like, getting sad and choked up, along with him.

And, like, the way that I pull myself out again is to just do stuff. So I jumped right in. And it was, like, I was back to being supportive and fixing things, you know. And I spoke to his dad's doctor, and I told him, you know, what he should say to his dad, and what information he should try and get from him about what his wants would be about intubation. And, you know, I suggested that it's worth a shot, because his dad wasn't a sickly person, he was, like, relatively healthy and young, didn't have a lot of other medical problems. So we had come up with this plan. Me and his dad and his doctor and him, that we were going to try intubation, and then get him over to a different hospital for the remdesivir trial and give it a shot. And so we did that.

And it was, like, the beginning of one of the heaviest months of my life. Every day, for a month, I would rearrange my whole schedule so that I could be there with his family when they got the update call, and talk to the doctors. And I conjured, like, all of my critical care knowledge from residency. And, God knows, I hated being in the ICU. But apparently I learned something. And for a month I just couldn't think about anything else. I was just focused on trying to find the way through, you know, the path that would get his dad off the ventilator and out of the hospital. And it was just this nightmare of a roller coaster, where, like, he would get a little bit better, and then I would get a call from, that he's getting a little bit worse, and then he would get better again. And then his heart failed one day because his lungs were so stiff, and it was, like, then we thought it was, like, eminent like, this is the end. It's gonna happen or whatever, like, he's gonna die. And then the next day, he got better. And it was just, like, one of the cruelest things that we had such a low and then we had this high where he was, like, getting a little bit better. And for a few days, they were talking about maybe even leaning to extubate.

And then we get this call. And even though they'd proned them and paralyzed him and jacked up the oxygen and he was on veletri, they couldn't get him to ventilate and he wouldn't oxygenate. And so the doctor called and was, like, you know, “We're not going to escalate care anymore.” Though, I have no idea what they would have possibly done to escalate past that point, because they'd done everything. And I understood what she was saying, you know, as a physician, I understood. And he'd been proned for the maximum amount of time and they had to flip him back over. And I knew that when they did that, if he was having trouble oxygenating while proned, that he would likely die when they flipped him over, when they supinated him. And, like, so I heard this. I was like getting this message from the doctor, but I knew that my ex and his sister didn't hear that message. Like they were, they were just hopeful.

Like, this was their dad, and they were holding on. If there was a 1% chance that it might work, they were holding on to that. Because who wants to live without somebody they love that much, you know? And so I just took over the phone call and I was like, "Your dad is dying guys." And they both got really quiet. And I was, like, you know, “We tried everything, we did everything that we possibly could think of. And it just–we're not in charge of this. We're not in charge.” I was, like, trying not to sound sad, you know, but it–I'm very emotional even now about it. It was just hard. It was, like, the end of a hard month. Hard because I love this family like they're my own, you know.

But it's not my family. I don't even know what the relationship is. It's not my family, though. It's hard cuz it's him. And no matter how much I want to, how much I pray for it, I can't stop loving him. And after all this time and all the hurt, it's still the kind of love where I would drop everything to be there. It's hard cuz, cuz COVID, cuz sickness is like my nightmare. The most traumatic part of my life is being a patient. And my nightmare is suffering, not being able to breathe. And that's what this does to people. It suffocates them. They die alone.

Maisha Davis

So here we are. Space, the final frontier. It's kind of how this feels. Everything kind of feels like a captain's log now. I recently, on day five-hundred-twenty-five of quarantine, probably closer to, maybe, day ninety or so, had a friend reach out, someone who I hadn't spoken to in over twenty years, to ask me how I was doing. And I think many of us have experienced that–friends, family, acquaintances, exes reaching out, and trying to form connection. And I think we are living in a really unique time, where despite having our worlds really shrunk down to some, for some of us our homes or for some of us our rooms, there being an opportunity to create space and connection outside of that silo that COVID-19 has put us into.

So, I think, an interesting metaphor that came up for me is around collaterals in the heart and in medicine. We know about this, we learned about it in med school, that the heart has blood vessels. And the coronary arteries and veins and every muscle in your body has to be fed and these vessels feed the heart. And heart attacks happen when one of these vessels is completely occluded, and that causes death. But what happens, because the body is so resilient and so magical, and there's so much about it that will always be beyond our logical understanding, the heart makes a way. At times, the body can make things called collaterals. And these are blood vessels who grow and connect. They're a way around that roadblock, and allow us to survive in times when maybe we shouldn't be.

I think, for us now, in these quarantine times, these types of connections, whether they be one second or ten minutes, one month, or even many, many years, these are the ways in which people are finding ways to survive in this space. For me, as a frontline worker and a physician, it's opened up so much time to do things that feed myself and not just others. That's looked like, literally feeding me by cooking way more than I've ever done. It means that I've been able to paint murals on my wall, and sketch, and dance in my house, and sing. It means that I went from maybe three houseplants to at least twenty three, if not more, that are all alive,, by some miracle, and bringing me joy every day when I walk into my house.

But I think really, the thing I was most excited about this quarantine that I just hadn't made the, the time or space or way to do, was to build a sound system. I do extensive research into most things. And I, as someone said, I have my, my Venus is in Taurus, and I like nice things. And so I, slowly over the years, bought different components that have finally been put together into something that brings me a lot of peace every day. I scoured Craigslist during quarantine and found some vintage Bose direct/reflecting speakers that are standing speakers, in, like, a mahogany stain in, like, a triangle shape, that goes perfectly with this long credenza that I have that also is just geometrically pleasing. So now that credenza supports a turntable I bought a couple years ago, because really I just want to be a DJ. I found a wonderful Sony receiver to connect them to. I have long speaker cables.

And now I just, I live in a sonic wonderland. And I'm really excited about it. And yeah, I just, I think that there's nothing like being able to surround yourself with sound that either supports or amplifies your moods and your emotions and helps you express what sometimes cannot be expressed with words. And since we were talking about hearts, and since I'm a child of the ‘80s raised in the ‘90s, but also someone who really, really deeply invests in Black art and Black interpretation of art, I've been listening to this remake of "Heart-Shaped Box" a lot recently, and thinking about the original song and thinking about how different vocalists can have a different take and completely change the tone and the resonance.

Let's listen to Amber Marks's interpretation of "Heart-Shaped Box.” (MUSIC) She eyes me like a Pisces when I am weak. I've been locked inside your heart-shaped box for weeks. I've been drawn into your magnet tar pit trap. (INSTRUMENTALS CONTINUE)

Ashley McMullen

This has been The Nocturnists: Black Voices in Healthcare. I want to thank our core team executive producer Kimberly Manning, The Nocturnists' founder Emily Silverman, podcast producer Adelaide Papazoglou, sound engineer Jon Oliver, and medical students Rafaela Posner, and Lauren Wooten. Thanks also to executive producer Ali Block and program manager Rebecca Groves, and communications intern Cora Becker. Our illustrations are by Ashley Floréal, and our theme song is by Janaé E.

Black Voices in Healthcare is made possible by the California Medical Association, the California Health Care Foundation, and people like you, who've donated through our website and patreon page. Thank you for supporting our work and storytelling. If you'd like to add your voice to our project, visit our website at thenocturnists.com. We'll be back next week. Until then, remember: Black lives matter, Black health matters, and Black stories matter.