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.

Emily Silverman

You're listening to The Nocturnists: Stories from a Pandemic. I'm Emily Silverman.

How does a pandemic end? With a vaccine or other treatments? Does it go out with a bang? Does it fizzle out? Or is there some nightmare scenario where it keeps coming back, relentlessly, decimating our society's most vulnerable?

What we know for sure is that the story is far from over. If anything, it's only going deeper, and awakening us to older wounds like racism, ageism, dysfunction, exhaustion. But something magical happens in these moments of breakage. There's space to imagine a different future.

In the words of Leonard Cohen, “There is a crack in everything, that's how the light gets in.” Here is episode 10: “Mourning.”

Suraiya

Today's Sunday. The day before Memorial Day, so it's that weekend when the rest of the country is partly opening up.

It's really hot in Los Angeles today, so you can probably hear my AC starting to blast. So I'm on my way to work. It’s 4:42, it’s 82 degrees out.

Today's disturbing news of the day: a hundred thousand deaths today. Today's Sunday New York Times had no pictures. It had a thousand names of people, their ages, and what they were known for, and what went missing in the world, because they're no longer here. And yes, a lot of people look at those numbers and say, “Oh, they're just elderly. They were–they were infirm. They had health problems.”

But what you're also missing out on is the relationships, the wisdom, the knowledge, the…the love, the experience, the stories. The context that these people put around our lives is gone. And it's not just their families that are affected. It's all of society.

And to say that somehow that's okay is to ask people to erase part of their humanity. And I think that's the danger we're facing right now, is that this episode is dangerous: it's morally dangerous. And that leads to a lot of questions.

Well, what matters in life? For us already to just let a virus rip through and take the most vulnerable in our society, then what really matters?

Medical Laboratory Scientist, Midwestern US

This is the medical laboratory scientist at a blood center in the Midwest, just giving an update.

So we got through the first wave, more or less, which is good from a COVID perspective, of course. From a blood supply perspective, it's maybe a little more complicated. Collections are down, I think, something like 60 percent.

But during lockdown, when they were only doing emergency surgeries, supply and demand seem to be pretty matched up. But now that everything is open with elective procedures and transplants and all that happening, we have so little inventory on our shelves.

I think, right now, we have five O-negs and no O-positives. Just none. For a center that supplies double digits of hospitals in the region, including a trauma center, my organization has maybe a day of blood supply, assuming normal use, like, no giant bleeds anywhere.

It's really concerning, especially factoring in all of the protests and police brutality and injuries that are happening with that. Meanwhile, we've lost a number of our chronic transfusion patients to COVID. Feels a little bit ridiculous to grieve for, you know, people I’ve never met.

They are names on a board that we, you know, keep a list of units that we have in stock for them. I test their blood sometimes, but I've never met them, but they're still my patients. And then having to erase so many names off the board in such a short time…it hurts.

I hope the rest of my patients stay safe, and that the protesters out there can also stay safe, and I wish this was a little more hopeful.

Pulmonary and Critical Care Physician, Detroit, MI

I’m one of the pulmonary and critical care physicians at Henry Ford Hospital in Detroit.

As I sit now we are at the end of week 10 of the COVID pandemic. We received our first patient on March 10th. I personally cared for my first COVID positive patient on March 14th. And we are still in the lockdown phase.

We are still in that suspended state where we are not in the before or the after. We're in the in between. And in this intermediate state, I think we're all trying to process what we've just seen and what we've just been through in whatever way we can.

I find a lot of what I do is just try to narrate back to people what they're experiencing. To try to narrate what I'm experiencing, because it's incredibly surreal. I went with one of our nurse practitioners to get antibody-tested the other day because my officemate tested positive for coronavirus.

We were walking through the tunnels of the hospital. And as we went through the tunnels, we intersected with a stretcher that was carrying a body with two attendants that appeared to be from a funeral home–they were dressed all in black. And our path to go over to the infectious disease floor took us behind this stretcher for a stretch of almost a half a mile, and we got very silent where we'd been very chatty.

And so I said, “I just want to acknowledge that we are walking behind a stretcher that is carrying a body who has died of this disease during a global pandemic.” And you hear those words out loud and you think, “That's a lot. That's a lot to integrate into our experience.”

One of the ways I've seen us compensate for this is through the use of rituals. There was so little comfort to be found early on that we all developed different rituals. We developed rituals around donning and doffing PPE.

We had rituals around decontamination. We set up areas in our home with a protocol that we would follow. We ornamented PPE. We acknowledged even as we played out these rituals day after day after day after day, that much of it was self-comfort–that we knew, for example, that a scrub cap knit by our friends was unlikely to really change our risk of illness, but that somehow arming ourselves with that felt like protection.

When everything is stripped away. When all of the things that we used as distractions are gone, we have a real opportunity to look at what truly matters.

Critical Care Doctor, New York

I've been avoiding telling this story because it's the first COVID-19 story that took a lot out of me, and made me finally test my theory that you can, in fact, cry in PPE. Not really sure how good your N95 is after you've cried in it for an entire shift.

I met this man in his early 70s who had not seen a doctor for several years. He came into the hospital because he was having a lot of chest pain and shortness of breath and palpitations. He was noted to have these hazy infiltrates that are highly suggestive of the coronavirus. To have all these lesions on his lungs–and multiple, multiple lesions–I think he probably had over a dozen lesions on both lungs, and a big lesion in his liver. He was also tested for, uh, the coronavirus and his rapid test was positive. He could not comprehend that the first time he managed to come to the hospital, he was basically facing the end of his life in one fell swoop.

Later during that day his oxygen requirement went dramatically up. All of a sudden, he was requiring a non-rebreather. He was starting to become confused, and was spending less and less time awake.

So I spoke to the family again, and I told them that things were worsening much faster than I had anticipated, and that now, we were not faced with days or even weeks, but in fact, we had, at best, hours.

They begged me to make provisions for them to see him because they could not bear the idea of their loved one dying surrounded by strangers. But unfortunately, I could not accommodate that request. We precariously moved this patient who was quite literally on his deathbed to the window, and we held the phone at the patient's ear.

He transitioned from living to death with his family speaking to him from across the window. It's really been one of the most tragic moments I have witnessed.

Um…I'm sorry to share a sad story, but I think these stories are important.

Heather, ER Nurse, San Francisco

I think it's been a full month since I recorded one of these things.

It's astonishing to me that we've been under this shelter in place order since mid February, and it's now June. Feels, on the one hand, like it's been the blink of an eye and it feels, on the other hand, like it's been forever. Time is passing in a very different way.

It feels like you don't know where to put your focus. The health care system in this country is a total disaster and a mess. That's been, I think, glaringly exposed by this situation. The populations that have been the hardest hit by COVID-19 have been the obvious populations that would be the hardest hit by anything, because they're not taken care of by our society.

That is something that I think we should be ashamed of. Trying to balance the economy, and the needs of the economy, and the needs to keep the economy afloat, with the needs of keeping people alive, is really challenging.

And seeing all of it, and feeling a little bit like I'm seeing it on the periphery, because here in San Francisco it's not as bad as it's been in other places. Every decision, every day feels like it sort of comes with an additional amount of weight. Even, you know, even seeing family carries extra weight, especially when you sort of carry this burden of being a health care worker.

I mean, I'm at the hospital, and what am I going to do, you know, reset my quarantine every single shift? Well, that means that I see no one, my family sees no one, indefinitely. We're talking a couple of years before there's some measure of vaccine, some measure of herd immunity. I mean, really, we're talking a couple of years.

These things aren't feasible, aren't sustainable.

Everything feels like we don't have any control over it. You know, I don't have any control over the economy. I don't have any control over how rampantly it spreads. I don't have any control over whether my children will be able to return to school in the fall. So it just feels so big, I think when something like this touches every aspect of your life, you…you–you can't take it on. And that's not a feeling that I'm used to having.

You know, which then leads me to ask myself, well which, where–where do my obligations lie? Do my obligations lie here in my home with my family, keep them protected, keep them safe, do what's best for them educationally, psychologically?

Do my obligations lie at the hospital, with the people who need care in the immediate moment?

Do they lie with the system, and fighting for improvements in the system that will stop wasting exceedingly gross amounts of money on bull that doesn't help anybody? Is that where my obligations lie?

It’s a brave new world. It's a weird new world. It's a–it's a hard new world. It's a confusing new world. And it's a world that I want to see come out of this better than it was before.

But I feel like each one of us is going to have to do our part to make that happen. And I don't know what my part is.

OB/GYN, Northern California

I’m an OB/GYN physician in Northern California. And after the weekend, I've just been so distraught and…upset and heartbroken over the death of George Floyd and the despair that so many people are feeling that their lives don't matter.

I was back at work on Monday, yesterday, doing another day of telehealth. And I think usually in my patient population is between 5 and 10 percent African-American patients.

But yesterday, it seemed like at least 50 percent of my patients were African-American. And, man, the weight of trying to get it right for these patients who I imagine are just despairing that they're not going to get equal treatment. In fact, their life is at-risk when they come to see me.

And so I was just really trying to take my time to be thoughtful, to answer every question, to try to do the right thing for each and every single patient I saw. And then, I had a pre-operative visit with this very stately elderly Black woman. And we got to the end of the conversation and she paused.

And then she said, “You know, my mom taught me from the time I was young that I would really have to advocate for myself, and really kind of make a fuss in order to be heard, because I'm Black. And if I'm going to get a doctor to listen to me, it's going to be hard work.” And she said, “I just want you to know I'm–I'm trusting you to take care of me and to treat me like your own sister.”

And of course, I was trying really hard not to cry because I'm trying to do my best and I'm just not sure if it's good enough.

And it reminds me so much of what my patients told me in my training. I trained someplace where about 90–90 percent or more of my patients were Latina and they would say in Spanish, “Soy en los manos de Dios y ustedes.” I am in your hands and God’s.

The statement my patient made to me yesterday reminded me of that: the weight of being a physician, and having the patient's life in my hands. This statement yesterday just had so much weight to it. And I–I sat down, I took my fingers off the keyboard, and I just told her, “I am so humbled by your trust, and I'm going to do everything I can.”

Such a horrifying privilege to be a physician these days.

Colleen, IM Resident, New York City, NY

I'm a resident physician in New York City, finishing up my internal medicine residency.

I last shared some reflections at the end of March over two months ago. And in some ways it feels like ages ago. It's hard to make sense of everything that has happened in the last few months, and what's continuing to happen. My role in the COVID pandemic has been a mix of extremes.

I spent a lot of time working in the intensive care unit in our public hospital in Manhattan. I was there during the surge of COVID in New York City when we totally overflowed–not just our medical ICU, but the entire ICU floor–and had to set up satellite ICUs in other parts of the hospital that weren't meant to be ICUs. And that was its own kind of chaos and intensity.

And now the attention of our city and so many of us has rightfully shifted to the Black Lives Matter movement and police brutality. That's a struggle that's been going on for so much longer than the COVID pandemic.

Racism in this country fueled the inequities we saw in who is dying from COVID, and so they're not even two separate things. They're–they're so intimately intertwined. My life now is very different from what it was before. The surge has passed and at the same time, it's really hard to make sense of what happened in the hospital during the COVID surge.

I read somewhere that the frontline health care workers in Italy had a lot harder time from a mental health standpoint when things started to go back to so-called “normal” than during the surge. And that really resonated with me: adrenaline energizes me, and I think I respond pretty well to a crisis. That's why I decided to go into critical care. It suits my personality and my makeup.

So when COVID began, I was all in there. It felt kind of exciting and I felt purposeful. Now that feels like it's all over, and I honestly feel very alone.

And it's hard for me to say exactly why that is. What we saw and experienced was just so unlike anything I'd ever seen and just the horror and tragedy of it.

I'm feeling an intense need for mourning and memorial, and that just didn't happen, and that's largely, you know…this is all occurring in a much larger context of where our country is. And there was not a national acknowledgement of so many lives lost.

For me, personally, as one person who happened to be training to be a doctor in New York when COVID came, and who happened to be in the ICU, and who happened to be the person holding the cell phone as someone said goodbye to her partner of 30 years because she couldn't be there…

Over one hundred thousand people died in this country alone. This isn't the ending at all. We need space for mourning and memorial to honor those we have lost and the pain of bearing witness.

VIOLIN PLAYING "HALLELUJAH"

Emily Silverman

That's our show.

Before saying goodbye, we wanted to share a special thank you.

In this time of the COVID pandemic, when people can't come together to tell stories, much less to sing, we wanted to try to do something we can’t do in person right now.

So we asked you, our listeners, to send in audio clips humming along to Leonard Cohen's “Hallelujah,” and from it we stitched together a choir.

CHOIR HUMMING "HALLELUJAH"

Emily Silverman

Over the last ten weeks, we received more than 700 stories.

Many were submitted anonymously, but stitched together they form a tapestry that showed the world how COVID hit us as a community of healthcare workers.

Thank you for sharing your voice.

CHOIR HUMMING “HALLELUJAH”