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Emily Silverman

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

It's the middle of May. The season for finales, graduations, transitions, cross-country moves. And it feels like we've all been holding our breath, waiting to turn some corner. The truth is, the crisis of this virus is far from over.

But we're desperately seeking a change in narrative. It's unclear what the future holds. Is the worst behind us? Is the worst ahead of us? No one knows.

But now feels like a good time to exhale, and appreciate the small wins. More testing, more data, some encouraging clinical trials. This week, you'll hear voices from North Carolina, Michigan, Maryland, Oklahoma, Colorado, and California. Take a listen.

Sarah, Radiologist, North Carolina

My name is Sarah. I am a radiologist in North Carolina. I'm in my final months of training, final months of fellowship year.

So, it's a big period of transition: transitioning from trainee to attending this summer, and also growing my family.

So my daughter was born on March 13th, 2020, right at the beginning of all this madness. And I've been on maternity leave since then. So she's a little over six weeks old. I don't have any heroic stories of treating patients in this pandemic. But I have been really struck by how similar the emotional, and honestly existential turmoil of postpartum life, is with what's been going on with this pandemic, period of isolation and quarantine.

It's just been really strange, the timing of this all, um. My last day of work at the hospital was Thursday, March 12th. At that time, we were certainly talking about the virus and upping our hand hygiene a little bit, sort of encouraging clinical teams to call us instead of visit the reading rooms for consults…but not really enforcing that. And still doing a bunch of elective procedures and scans. My daughter was born at 4am the next day, on Friday the 13th.

I was discharged on Saturday, and by Monday it seemed like the world had shut down. My older daughter's daycare was closed. So she's been home with us this whole time.

Our radiology department instituted a bunch of new staffing and social distancing changes. So half of our department is working at any given week. The other half is off, and workstations computers have been moved the standard six feet apart.

They've limited movement of residents between services, that kind of thing, and canceled a bunch of non-urgent procedures and scans. All of this seemed to happen over the course of a weekend. So not only did my world change, it seemed like everyone else's did, too.

Um, when you have a baby, it's common and normal to have a lot of fears, anxieties a few days and weeks after their birth. You know, you worry about them gaining weight. Are they eating enough? You check on them a million times at night, at least I do, um. But it's been interesting to have other fears on top of that, that I didn't expect during this period. I read that women who are diagnosed with COVID-19 are being asked to isolate from their newborns, which the doctor-side of me knows makes total sense. Newborns are vulnerable.

But the side of me that's a mother is terrified and aghast at that recommendation. You kind of have to have had a baby to understand that sentiment. The thought of not being able to hold your baby, nurse your baby, is pretty scary.

I also read that laboring women are being asked to wear masks now, which seems like the kind of rule that was made by a man. Again, understandable. But the thought of going through that wearing a surgical mask is pretty hard to fathom.

Anyone who's been through labor understands that, too. I'm really torn between being frustrated and disappointed that my maternity leave hasn't looked like I wanted it to.

You know, I haven't had family and friends here to support me. Most of my family, with the exception of my husband and mother, have not met the baby. I've had to take care of my two and a half year old at the same time, which I know in retrospect I'm going to cherish this time with her, but right now it feels really overwhelming, and feels like this baby is just kind of along for the ride.

I haven't had as much of a chance to bond with her, but on the other hand, my leave has lined up almost exactly with the peak time of this pandemic, which means I haven't had to be working in the hospital. It's going to be interesting to go back to work in a week and a half.

My husband is going to be taking care of both the kids and working from home, which is no easy feat. And I expect it's going to be really hard on both of us. They are starting to reschedule some of the oncology scans and those types of things that were put off during peak infection.

So I actually expect it's going to be pretty busy, um. So we'll see. We'll see what the future holds. I just at this point really want things to go back to normal, but don't we all?

Neuroimmunology Fellow, Maryland

My name's Emily, I'm a neuroimmunology fellow in Baltimore.

Uh, I have had COVID. I'm now 28 days from developing symptoms. I was pretty sick, but luckily I was able to ride it out at home. I'm doing pretty well.

My cat, which you heard about, is not doing so well but he's actually kind of recovered a little bit in the past couple of weeks. I'm putting off putting him down, but we'll–we'll see how he does.

I've been thinking a little about getting it, and what it's meant, and kind of going forward. One interesting thing that was going on in my life at the time that I developed symptoms back in April was the three-year-anniversary of my dad's death, which was very sudden, and um…I had been pulling out pictures of him and thinking that maybe I could start going through some of the boxes because it had been pretty hard for me the past couple of years. I was in the middle of residency and I just kind of had to deal with the situation, and sell all of his things, and pack it up, and sell his house.

Um, so, I had brought out those two boxes and I was going to try to take some pictures, digital copies, to my brothers. And then, that was the exact day that I–I started getting symptoms. I don't know if that's a coincidence. I don't believe in the universe stuff, but it's very interesting: his mortality and my mortality.

And then, today, day 28, was pretty exciting, um. I'm participating in a COVID plasma therapy through Hopkins, and I went for my initial appointment of donating some blood for antibody testing.

If I have antibodies, which I should have, hopefully, then I will go back and donate plasma. Um, so I'm really looking forward to that. It's pretty cool to think that I've got medicine running in my veins. It's just as good as llama antibodies, although llama antibodies are smaller.

That's the immunologist talking.

Tessa

I've been thinking a lot about families over the past week. Like a lot of other hospitals, my hospital has a strict visitor policy that was enacted in the beginning of March, which has meant a lot of births and deaths unwitnessed by loved ones.

Yesterday, I had to ask a family member who was in the hospital without a visitor exception to leave. And it was extremely hard.

My favorite part of being a doctor is talking to patients' families, and that's just not been the same over the last month.

We're still communicating with patients' families. Of course, we're talking to them over the phone at least once or twice a day. We've been using FaceTime, but it's not quite the same as seeing someone in person and having them there.

I used to get pages that would read: “Family is at bedside. Can you come and talk to them?” Now I get pages that say: “Family is at bedside. Visitor Relations would like to talk to you.”

I'm not a bouncer. I'm an intern. What I also find frustrating is that Michigan has relaxed its shelter in place order, which means that golf courses are allowed to be in operation, and people can go on their motorboats.

I walked by a golf course this morning, and no one was wearing a mask, and people were not standing six feet apart.

So my vulnerable patients now can't have visitors in the hospital, but people can golf? I realize and recognize that the hospital is a high risk environment, and I get why we can't have visitors, but it's extremely hard when you feel like you're robbed of the best part of your job, which is taking care of patients with their best advocates at bedside.

What is good is I feel like doctors and nurses have really stepped up in their roles with new passion, and I think it's probably because we’re realizing we have to be a lot more now.

Dr. Berry, Family Doctor, Oklahoma

This is Dr. Berry in Oklahoma. We continue to really kind of dodge the bullet out here in the country. Our county has only had two cases out of a population of about 3000 people, so doing pretty well.

We did have a local nursing home worker who contracted the virus and actually died. She was in her 30s, and had some kids at home, and that was tragic. But thankfully, the residents in the nursing home all tested negative. And so that's kind of blown over.

Our little town is kind of going back to normal, a little at a time. Tomorrow is the big day when things begin to open up in our state. You know, we're just planning, I guess, planning ahead to see kind of how to move forward. We're still, um, kind of wearing masks around patients, and we're asking them to wear masks. We're still meeting people in the parking lot and taking their temp.

I did do a test today for COVID-19, and it has become much smoother to order. That process has really been worked out well by our–our health department and state, and one of the universities here in the state has really stepped up. And so that was just really seamless, really easy, uh. We don't have an abundance of swabs or tubes, culture, media to transport that in, but we have enough for now.

Our little country church where we attend is actually going to have in-person services this Sunday, and I have kind of mixed feelings about that. They've done some rearranging on the seating to kind of space people out, and they're encouraging people to social distance. But I think just the nature of that type of gathering, a church gathering, is that people show physical affection for each other.

There's lots of hugging and embracing and handholding, and seems like they are more openly physically affectionate there. And so I don't know, it'll–it'll be interesting to see how that goes and how, how strict people are going to be as far as following that.

I guess the big concern I have now is that as things open up, um…it would really just take one person in one of these group settings–you know, a wedding or a birthday party or a ball game or anything like that–to really get things going again, and really overwhelm our little small town health care system.

Rachel, Medical Student, Denver

This is Rachel, I'm a fourth year medical student in Denver. Life continues pretty much the same here. Um, we've inched passed the peak. And our um, our case rate, our admissions rate is starting to go down.

I'm leaving soon. I'm starting to pack up my apartment. I'm going to residency in Cincinnati, which I'm really excited about. I love to move, and I love meeting new people and seeing new places. And I've always moved, so it's something that I expect, and I enjoy.

And something I noticed about moving is that I love the place I'm leaving so much more right before I leave it. And so as I go running around Denver at night to avoid the crowds and to give my body the feeling of being able to run away from the threat, so that it can tell my mind that we can run away from the threat–because my mind certainly can't run away from coronavirus–and there's a little bit of healing, and a little bit of peace.

I'm just savoring the city, and the place I live in Denver has a lot of porches, and so people are out on their porches in the evenings, which is something we always do in the summer. And you can smell the barbecues, and some people are still using their wood stove. And so those come through intermittently, and we're passing the peak of tulip and daffodil season. It's quieter in the city now, you can hear bugs startle in the grass as you run by, which is something I'd never heard before, and I scare a lot of bunnies.

The bright spot in my day was that, um, the doctor whose daughter advocated for him to get convalescent plasma and who was the first person in our state to get convalescent plasma, is on the floor now at the hospital and calling his family after 34 days in the ICU.

And I'm just so grateful that there's that little bright spot, and I'm really happy for him, and I hope he does well.

Alex, Meds-Peds, North Carolina

This is Alex from North Carolina. Things still have not been crazy for us here, for which I feel really fortunate.

I will say that one thing that has really struck me is over the last couple of weeks, I have had three patients of mine die suddenly, either in the middle of the night or after rounds. Obviously, this is something that happens for all of us, and particularly those of us who take care of an older population, the sicker population, and patients with lots of chronic medical issues.

But it was just really striking the number of, uh, patients for which that happened recently. And I have to say, you know, since everything we do right now is colored by the coronavirus pandemic, in that context, it's hard to ignore the possibility that all three of these patients may have had COVID-19.

The most recent one who died this weekend was an elderly man who came in with just sort of generalized weakness. But all of his labs really made me very concerned for COVID-19, and we continued to treat him as if he had COVID-19, even though his tests came back negative twice. I just didn't have another great explanation for what was going on with him. And I was stunned to hear from the team that he had died suddenly in the afternoon on Saturday.

You know, another patient of mine who died suddenly recently had unexplained fevers after surgery. Certainly lots of possibilities for post-operative fever. But, in his case, I also wonder, it was relatively early in our coronavirus outbreak here–but that was actually before we were implementing widespread testing and our infectious disease doctors had actually recommended not testing him, because at that point, it was taking us 10 days to get a test result back, and they didn't want to expend PPE on him every day, given that there were plenty of other possibilities for his fever. But I will say that none of the other possibilities ever panned out. He died before we could complete a lot of other testing.

Given what we're hearing from other places where this pandemic is really raging out of control, like in New York City, the number of sudden deaths and cardiac arrests are really high, and make me concerned that we're missing some patients who may be dying from this disease. And we have no idea. Sometimes, maybe even if we're testing them, based on my patient this weekend. Obviously, plenty of other things could have happened. And that's what makes this time so hard is…just the uncertainty.

And sometimes you feel like you're being paranoid or overreacting, and sometimes you feel like, am I being stupid? Am I missing an obvious COVID-19 related death? If you're not thinking about it, so you just…I feel like I go back and forth all day, every day between overreacting and underreacting.

Perfect case happened today. We are admitting a guy who had about 10 days of sort of vague flu-like illness and then pulmonary embolism. And his COVID testing is negative. Um, but, you know, in the, in the current context, I still have to presume that this guy could be COVID-19 positive. Yeah, It's just, it's so hard to know if we're making appropriate medical decisions and that uncertainty just eats at me. I think I spend more time reviewing my medical decisions right now than I ever have.

The other update I have right now is I just heard from my wife that my daughter, who is about to turn seven, has a fever to 102…which on an ordinary day, I'd say, you know, hope she feels better and, you know, go home and snuggle her, and she'd be over it in a couple of days because we're fortunate enough to have healthy children, and it wouldn't be a big deal.

But right now, it is a big deal. They haven't left the house, but obviously I'm going to and from work. So where did she get whatever infection she presumably has? Did I bring it home from work?

So much uncertainty right now, but I think it's really–it's really striking to me that I've been so worried, so paranoid about bringing this virus home from work. Um, I've been doing all these things to try to prevent bringing this virus home. And now I'm worried that going home tonight, I may be exposing myself to this virus, and possibly even bringing it back to work, exposing my colleagues, exposing my patients.

Infectious Disease Doctor, San Francisco

I'm an infectious disease doctor in San Francisco, still in my fellowship, although at the very end.

I think I haven't really, um, said much because I've been a little bit down just thinking about, you know, all of the consequences of this: how long it's going to last, how much more social distancing, physical distancing we're going to have to continue to do.

And I have this old way of reacting to very stressful things. And I did this a lot during residency, where I just bottled it all up, and I wouldn’t talk about it. Like, for example, I wouldn't call my parents and talk to them. Because what is there to say when you're working 80 plus hours a week? There's just not much to say that's good. And I've sort of felt that way, like I don't want to talk when things aren't great. And I even do that in my audio diary, which is funny.

But anyway, today I feel better because we started this big study in the Mission. We're doing a paired serosurvey–so doing antibody testing along with PCR for active infection, and hoping to capture a large portion of the zip code 94110, where there's been quite a few cases here in San Francisco. And get an idea of the cases that you diagnose in the hospital are only like a fraction of the true caseload. And so you really want to know what's the true attack rate of this disease and in our community.

And it's cool because I live just two blocks away from the study site that I ran today and, and I work in the lab that's going to help process the antibody samples and do some of the antibody testing. And it really is like this, one of those rare moments in your life, or at least it's been rare for me for it to be this connected. The translational medicine, just like, there's a new pandemic. I am getting to help run a study that is going to answer some fundamental questions about the disease in the community that I live and work in. And I mean, what is more, what is more fulfilling than that to an infectious disease doctor? I can't really–I can't really think of anything better.

So even though I'm sunburned and exhausted and I was outside from 7am to 7pm, and I still have 20 cryo boxes to fold and get ready for tomorrow, I do feel, like, a sense of purpose today.

And I do realize that, you know, as dark as these days seem, right, nothing lasts forever. And I am honored to get to be a part of the plethora–I mean, my God, the army of scientists–that is working just to understand the basic fundamentals of this disease with the hope that people that are much smarter than me can design therapeutics and vaccines. And I can get back to studying malaria, which is what I used to do in my pre-COVID life.

So I just want to say that today was a good day.

Anonymous
Today is April 26th. It's a Sunday, five o'clock, and, yeah, I'm in the hospital, even though I'm supposed to be off, but I don't care today.

Because I am…I'm walking through the basement and I'm looking at a unit of convalescent plasma, like I'm holding it in my hand and walking it to the ICU right this minute because my hospital is lucky enough to be one of the sites for research that we've got something in our arsenal that we think really works, and it's really cool.

I've watched everybody perk up at each stage of this process of, “Hey, we got registered as a site.” “Hey, we consented and enrolled our first candidate.” But now that, now that it's here, now that I'm looking at it–it feels ELEVATOR SOUND: GOING UP so much better.

When I go in to consent another person in another room, while we're waiting on it to thaw, I feel hope. We feel energized.

And so ELEVATOR SOUND: SECOND FLOOR I think that's what we all need right now, because the hope and the energy is losing it. But, you know, it's those little things. The patient that we discharged from the rehab unit to go back to his family who was up and walking and going to be like his normal self–that, that was a win too, that was a good one.

So yeah, really excited to walk through the ICU doors and go hand this off to the nurse who's going to hang it for our really sick, proned, ventilated patient who is…happens to be one of my primary care patients through sheer dumb luck.

Today's a good day. I don't mind being at the hospital today. I'm so glad I decided to just come in.

As I was walking the first unit up to the ICU, I get the email that the second unit is here, ready to be transfused, and we've got a recipient for it. And it's somebody who I consented, who I got to look in the eye and tell them that we have something that we hope will help. The interesting little twist, as I was talking with the nurse who was getting ready to transfuse the unit in the ICU, happened to find out that she's on loan to us here in Michigan from her native hospital in New York.

And that made me stop for a second and think. Think about the two people who donated parts of their body, literally sat there and gave part of themselves to somebody else, asking absolutely nothing in return, and a nurse who comes from the hardest hit spot in the country to come help us.

And she was so excited about giving this unit and excited to go back and tell all of the folks back home about what she was doing. This feels right. This–this feels like the medicine that I set up to do, not what I've been seeing, not this “maybe it'll work, maybe we're helping people, we don't know if we're hurting them” and the infighting and the taking other people down.

No, today–today was a good day. Today was all about building each other up. The patients, the staff, everybody. FOOTSTEPS

All right, last bit of good news for the day. Just left the hospital.

And the sun is out. It's gorgeous outside, but best thing–the very best thing–is the refrigerated trucks are gone. That was, that was one of the ugly days early on when I first saw the refrigerated trucks outside our hospital. And now I'm looking at the spot where they used to be because I parked in a new spot on a Sunday afternoon knowing there wouldn't be anybody around. And they're just gone. And none of us wanted to talk about why they were there in the first place.

And we're still going to lose patients. There's no question there. But, things are starting to feel more like we can, we can handle the bad stuff, and there's more good stuff. All right. Now that's really it. But, yeah, three good things today.