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.A pandemic is an all hands on deck situation. We've heard from outpatient doctors going back into the hospital, generalists who are learning how to operate ventilators, and medical students who are graduating early to lend a hand.But at the same time, appointments are being canceled, elective procedures are being postponed, and hospitals are cutting back. Some of our diarists are finding themselves without a job, along with many other Americans. And others are finding themselves sidelined because of their own health issues, or those of their loved ones.In this episode, we explore what it's like to be on the outside of this pandemic looking in. And it's called “Helpless.”

Anonymous

There's an article in the Winter 2015 edition of the Wilson Quarterly entitled “Left Out of the Greatest Generation” about a group of men who, for whatever reason, were left stateside during World War Two. It describes their feeling of isolation and feeling left out from what became a defining moment in American history.I now know how those men feel, at least to an extent. You see, with my wife's cancer, my partners have made arrangements such that I will not have to care for patients with COVID. I'll be seeing patients in clinic virtually and performing logistics and leadership functions for our group, but will not be expected to take any of the night call, or be in the intensive care unit during this time.I'm extremely grateful for this gesture. It's clearly one of sacrifice and love, and I'm just beside myself with pride and happiness at having partners who are like this. And at the same time, I can't help feeling left out of what will likely be the defining critical care illness of an entire generation of intensivists. So I'm ambivalent.On one hand, I'm extremely grateful because bringing home a virus like this to my wife in an immunocompromised state would be devastating. And on the other hand, not leading from the front is very difficult. I think about that a lot.

Rachel

Hi, it's Rachel. I haven't posted anything this week because I haven't done any in-person patient care…for kind of a tough reason, which is that I decided that I should stop.I have some pretty severe asthma. I have been hospitalized a number of times for severe asthma in the setting of viral infections…um, and take prednisone a couple of times a year for such exacerbations, even when it's well controlled. And so I have done a lot of soul searching this week about whether it's a good idea for me to see patients in this time.I think on the one hand, we all expect, and I think–honestly let’s be real: not we all. I went into medicine because I like to help people and I want to make them better. And the whole bedrock of medical professionalism sometimes seems based on self-sacrifice, like, “Yeah, you're tired and that person is coding. So do CPR and figure it out later.”And so I really imagined that in a situation like this, I would be on the front lines. I have a lot of the skills to be on the front lines. Not only am I a primary care doctor, I'm also, until this past year, a hospitalist and totally capable of caring for patients with COVID. People like me are needed, but I should not be working. And so–or not seeing patients in person–but I just feel like an asshole.I feel like I'm leaving my colleagues in a bind. I thought that this wouldn't be an issue because most of the clinics in our network have–essentially have vastly scaled back in-person operations, and are doing telephone visits. And I said, great, that sounds perfect. But then my clinic, because it's physically located in the same address as the hospital, got turned into overflow, urgent care for the city, which is another way of saying that it's overflow, urgent care for the emergency department.And we're being understandably asked to do more clinical shifts to help staff it. And so, I was having to decide whether I was going to see eight patients in a half day over and over and over again with my crap, shit lungs, which also have chosen this moment to get worse. I'm taking more daily medicines for my asthma than I have in a long time, and I'm usually a runner, but lately when I try to get up a hill, it's pretty hurty.So my employer has said, you know, “Talk to your clinic medical director about this.” And my clinic medical director understandably was like, “I don't know, talk to your doctor.” And my primary care doctor, who I've met once, because I am a doctor, and so I just tell them what to do, like a jerk. He also said he didn't know what to do.And so I took this to be a sign that maybe I should just work, and have been working but feeling like it's the wrong move. I thought a lot about it. I got a lot of shit from a lot of people who love me, my husband, my mom–my dad is dead–my siblings, my colleagues, who every time I saw them in clinic have said, “Why are you still here?”And finally bit the bullet. I talked to my own boss who said that she understands and that it's okay for me to scale back my in-person work. I don't know exactly what that will look like, but I will say that I'm really worried about the people who don't have COVID, but do have other complex medical problems and how we are going to keep those people away from health care settings for months.It's going to be really hard to figure out how to do this from the sidelines because it is really tempting to be in the middle.

Speech-Language Pathologist, Oakland, CA

I am a home health speech-language pathologist in the San Francisco Bay Area.There's a whole lot of questions and not a lot of answers. I think for home health right now, what I've experienced has been a lingering anxiety and question about the essential nature of our jobs. In home health as a speech therapist, I'm doing a lot of education and training with caregivers on feeding, diet modifications and recommendations, swallowing exercises, getting people on their least restrictive diet, educating about aspiration pneumonia, sending folks out for instrumental studies of swallow. I have trach-vent patients. I have very frail patients who are near a hospice transition.I love my profession. I think we're, we're vital parts of, of a team. But we're in a, in a new world, it feels like. Is the cost benefit of me seeing these sometimes frail patients worth it? I know that I can be a carrier.This keeps me awake at night. I think that most of us get into health care to help. And it's really, really hard to feel like you may be not on the right side of their care by being in their home. It definitely weighs on me at the end of the day.So today, I saw a gentleman who's in his 80s and has many, many things going on with him, brought to home health after a recent hospitalization for pneumonia, likely aspiration pneumonia. So I did the visit, I had goggles and a mask and was trying to be as close to him and as far away from him as I could be to do some swallowing exercises and some diet trials. And I felt like that was a service that was needed.I feel really strongly right now about folks who are a high aspiration risks, keeping them out of the hospital with a pneumonia that…that we could…we could do our best to prevent. But there's this little doubt in my head just won't go away of, if I'm–if I'm doing the right thing by making the visit.It seems like every decision that I make these days, I have a little voice in my head that says, “Are you sure? Is it essential?” And then there's, you know, a really bad one that comes in and asks, “Are you–are you just blowing this person off? Are you being lazy? Are you being a lazy therapist?” I mean, that…that is a hard one. I don't even really want to admit this on a recording, but I had said the other day and to my partner that, “You know, I–I'm tired of this. And I just I would I hope that I get it and that I'm sick and then, that I'm home. You know, so that at least these questions of am I hurting people by seeing them? Am I hurting people by not seeing them, could stop.”

Pediatrician, Texas

Today is Sunday, April 19th. I'm a pediatrician in Texas, I've been reflecting a lot this past week on the ups and downs of my feelings.When I think back to March 11th, which is when I would say the full impact of COVID-19 hit me in the face, to where I am now, a month later, I can't believe how much has changed.I went from being an active pediatrician, working, being afraid of getting the virus, to thinking that I had the virus, to being grateful that I was better, and then the anger at how the system was handling the virus, and feeling like I needed to get the word out, feeling like I needed to help improve the system, to then being laid off and suddenly being at home, taking care of my kids.And, at first, telemedicine was very fulfilling. I felt like I was talking to a lot of patients and really helping out. But now that we're getting into the middle of April and Texas is lifting their stay at home orders, the telemedicine is dropping off.And now, I'm just a pediatrician not working. The feeling of being lost comes in when I don't know what my future holds. I feel like some days I want to make a big career change. I thought about getting a master's in public health. I thought about maybe trying for a second residency in some type of specialty.And then other days I get the gratitude that I'm home, that I'm with my kids, I'm taking care of them. But then the shame hits, and that's the hardest to deal with as I watch all my colleagues fighting the good fight, as we say, and I'm not there, I'm not with them. I'm not in the front line.And not all doctors have that instinct to jump in and face risk, but most of us do. If you don't have it at the beginning of residency, you usually have it by the end. That instinct to jump into the middle of something that's terrifying for the average person because we know what to do, we're well trained.And I can't help but think back a couple of years ago when I was at work, and there was some shouting in the waiting room, and my staff ran back to get me, and they said there was a man beating his daughter in the waiting room. And he was in a rage. And I remember the first thing I did was took off my glasses. I took them off, and I ran out to the waiting room, shouted and–and didn't think twice about whether he had a gun, or if he would attack me, and–and he ran off. Ends up that man had multiple warrants out for his arrest, and I didn't think twice.And now when I think about that, I realize that there must be other people in my position who were ready to take off her glasses, were ready to jump in, and we've been let go. And it's not a good place for doctors to be.ICU Travel Nurse, North Carolina
I work as a travel nurse. I'm currently at a hospital in North Carolina. I've been here since November. I travel as either step down or ICU, and I'm in a step down position right now.This is a very strange time nationally. Where I'm at right now does not have very many cases and the city hasn't been very affected. But where I'm seeing the biggest effect locally is in our staffing.When the COVID started coming out, our hospital, at first upped the number of traveler contracts that they were accepting, I think. But some of my friends have been there since January and December like I have. And now we can't keep our hours. I think last week I worked the most hours out of the travel nurses, and I only worked 19 hours. I've tried to get contracts. I've tried to cancel this contract early and maybe get a job someplace else that has a higher need.And even so, I can't get hours out there. And then yesterday, I got a call that they were canceling my contract. It's very strange that in this time that, you know, is a pandemic and we have a certain set of skills that can be used, you know, we still can't…we still can't contribute. And that's kind of hard to sit on the sidelines. Our hospital doesn't have very many COVID cases right now and hoping that we don't.But what I'm concerned about is that our census has been so low. We've shut down whole units. We’ve put six or seven nurses on call each shift. And, you know, I'm concerned that where are all the patients who are, you know, having heart attacks? Or…where are the patients, you know who are having normal stuff?I'm–I'm concerned that once we pass, once we hit a tipping point, that there's going to be patients that haven't been coming into the hospital with symptoms for weeks and weeks just because they didn't want to be “in the hospital.”So I'm concerned that there's going to be patients with cellulitis who come in and say, “Oh, I've had a pain in my leg since the end of March,” or people are at home and not doing anything and drinking alcohol. And people are going to come in and, you know, with newly jaundiced eyes, with abdominal pain. And, you know, you ask, “Well, when did your eyes, turn, you know, turn yellow?” And I'm afraid the answer is going to be weeks ago.So I think our healthcare system, once we…I guess convince the public that “hospitals are safe again”...I think we're going to get hit by a second wave of just people who have been sitting at home and been too scared to come in for diseases that are not COVID-related.I think we're going to get so swamped. We've been putting six to seven nurses on call a night. But once those nurses, you know, have to staff their own, we're going to be so short, and those patients are going to come in so sick. It's weird to be an “essential” employee, and I can't get a job.I don't feel essential. I'm clearly not essential. My hospital canceled me. And then in general, with the…with how they're organizing all the PPE, I feel more disposable than I do feel essential. No, I don't feel anything.

Endocrinologist, Southern California

So it's midnight and I just crawled into bed, put my three kids to sleep, who no longer seem to have a regular schedule. This is my second day actually doing telehealth from my house.I'm in a solo practice in a small town. And so I've kind of had to roll with the punches. When I first heard about this virus, my husband, who is a pulmonologist, had been kind of watching what was going on in China.He's also the only intensivist and pulmonologist in the county, and he came home one day with bags of Lysol spray, bleach spray, hand wipes. And this was at the end of January. And I asked him what the heck was going on, why would he buy so many cleaning supplies?And he said, you just watch in three weeks, you're not going to be able to get any of this. And my husband was right. He's always said his biggest fear is a pandemic. And here we are. It's amazing how this thing has reached every corner of our lives.I'm worried sick about my husband, who is the only intensivist and pulmonologist in the entire county, and he's taking care of at least six COVID patients at this time. He gets consulted on all of them because he's the only pulmonologist, and we haven't slept in the same room for over a month. He eats in a different room. We have FaceTime dinners with him, even though he's in the same home with us. He comes home, he bathes in the swimming pool before he comes in and washes his clothes, sanitizes everything he touches, takes a shower, and goes into another room where he doesn't come out of. We deliver his dinner.The kids are stressed out. They're worried their dad's going to die. Their mom is working from home. It's all very bizarre for everybody. And I guess our life has always been a stressful life. But I've never been worried that he was going to die. He hasn't had a day off in over two months. He sees every single one of those positive patients. We're a small town, but we have our share, and the ICU is three quarters full.So I have to limit my contact, because we have three children to think of and both of us can't get sick. So this is the most surreal experience ever. I’m…training was hard. We had AIDS patients when there was really no treatment for them and they were dying, and we were worried we could get infected. We could get a fingerstick, but we never worried about sitting and talking with them in the same room.So he goes to the hospital every day. And I’ve turned my dining room into an office, and I try to do enough telemedicine visits to keep my solo practice afloat and not fire any of my employees and just break even. We're not living our lives in any normal fashion. I feel almost like a prisoner in my own home. There hasn't been a time in my life where I have felt this isolated.I’m kind of thankful for this diary because it's not something that you really want to talk about. I'm not an emotional person, but I've found myself in tears almost daily. I know we're going to get past this. I don't think any of this is going to be the same after this is said and done.

Pediatric Emergency Physician, NY

I'm a pediatric ER doctor in New York City. Um, I used to sing a lot. I don't sing as much anymore, but when things are hard, this is one of my favorite songs to sing. This is “Helpless” by Neil Young.PLAYING MUSIC AND SINGINGThere is a town in northern Ontario. Dream, comfort, memory to spare. In my mind, I still need a place to go. All my changes were there.Blue, blue windows behind the stars. Yellow moon on the rise. Big birds flying across the sky. Throwing shadows on our eyes.Leave us helpless, helpless, helpless. Helpless, helpless, helpless. Leave us helpless, helpless, helpless.

FADE OUT MUSIC