After leaving Vassar, Dr. Deirdre Lewis completed her medical degree at the University of Connecticut School of Medicine and completed her Internal Medicine/Pediatric Residency at University of Massachusetts-Baystate Medical Center. She is currently pursuing a fellowship in pediatric critical care (PICU) at a New York City area hospital.
This piece was first published by Medium in April and is reprinted here with the author’s and Medium’s permission.
Corona Delenda Est
Wham, wham, wham. The mattress groaned under the force of chest compressions. I was surrounded by the usual flurry of activity that accompanies a cardiac arrest; nurses passed medications, voices called out information, people took turns performing compressions. But there was a palpable anxiety running underneath. The patient had COVID.
I had my hand deep in the patient’s groin, feeling for the femoral pulse. I was standing close to the patient, not as close as the people pushing on her chest, but close. My hand drifted absentmindedly upwards to adjust my face shield, but the thought of getting the virus leapt to my mind and I forced it down. What a stupid way to get COVID, from touching my face during a code.
Meanwhile, the patient in the next bed could see everything. She was staring at me in horror. A nurse twitched the curtain back to block her view.
“Okay this is our last pulse check. Do we have a pulse?” The chest compressions halted. The room fell silent. I turned to look at the code leader, my fingers pressed deep in the artery.
“No pulse,” I pronounced.
“All right. Time of death 10:02 a.m.”
The patient in the next bed wailed. It was the third death I had seen that day.
Nine months earlier in June of 2019, I was graduating from residency, the first stage of training after medical school. The graduation was held on top of a mountain in Massachusetts, and I vividly remember how green the valley below looked in early summer as I stood on the edge of the next step in my career. I attended a combined Internal Medicine/Pediatrics program, meaning I took care of adults and children, and would be pursuing fellowship in pediatric critical care (PICU) at a New York City area hospital. I would miss taking care of adults, but PICU would be challenging and meaningful. I was excited for the next step.
In January of 2020, six months after that day on the mountain I, like many doctors in the US, was reading the reports of COVID-19 emerging in China. In late February I was reading about it in Washington state. I was not worried at first. I studied acute respiratory distress syndrome and ventilators and lung compliance, and was this not just another respiratory virus? Was this not what I had chosen to do with my life? Then the first case in New York City was reported in the media. But she had traveled from Iran, a known hotspot, I was not overly concerned.
But the virus, a deadly miasma, was already stalking through the city; an invisible malice that lurked on shopping carts and doorknobs. Confirmed cases began to arrive in early March. At first we heard of one on the adult side. Then three. Then ten.
Then the dam broke.
From the PICU we began to hear the intercom go off three or four times a day, “Medical rapid response team.” Then once an hour, “Respiratory stat.” Then seemingly every half hour, “Anesthesia stat.” At every call we would all stop, heads cocked, stomachs clenched. The stress was so viscous I was surprised I could not see everyone’s chins turned up, bobbing on the intensity of it. I imagined people like me pounding on chests and pushing life-saving medications. I imagined patients gasping for air while the anesthesiologists in their hoods loomed over them.
I developed a crushing, overwhelming sense of guilt. I had training in adult care, I had skills that could be useful, I wanted to help. My anxiety rose as the full scope of the catastrophe crystallized. Now I understood why my great-uncle, desperate to get into the Marines during World War II, had eaten 32 green bananas the morning he went to the recruitment station so he would make the weight requirement. When the hospital asked for volunteers from the PICU to be reassigned to the adult ICU (medical ICU, or MICU) I signed up immediately, no green bananas required.
And then I went. And I met the full fury of the storm.
In each room was an intubated person, sedated, paralyzed, proned, completely cut off from their loved ones. And it wasn’t just the main medical ICU, it wasn’t just the smaller ICU upstairs. It was the recovery suite. It was the cardiac ICU. It was the cardiothoracic ICU. It was the short stay unit. Then there were the regular floors, where the patients waited for the moment when “Anesthesia stat” would be called for them. It seemed to go on forever, an endless warren of people dying by inches.
At the end of that first day, I came home and typed out a list of what my last wishes would be. I am not even 30.
The days began to spin by in a dizzying blur. Our schedules were formatted to spend time in both MICU and PICU. Meanwhile, my friends who are not in healthcare were desperate for news. I would tell them about my day. “Oh, it’s like being an intern again, I don’t know where the bathroom is!” I’d quip, as if I had any time to use the bathroom, even if I knew where it was. I made jokes about the differences between internists and pediatricians, I left out how many people I had seen die that day. I assured them I was healthy and safe. I lied and said I was not scared. I told them to stay home. We made our own catchphrase, based on the old Roman motto ‘Carthago delenda est’, Carthage must be destroyed. Our version ran ‘Corona delenda est’, corona must be destroyed. We made T-shirts.
My family life shut down. I told my grandmother, living just miles from the overrun hospital, that she could not leave the house anymore. I confirmed that she would not want a breathing tube. A few days later, I told my father to stop visiting. After that my brother left New York City. One night I was struck with how suddenly alone I was. Every holiday, every birthday party, and every vacation had all been given up in the fight against COVID. All that was left was work and sleep.
In some ways I am lucky. Several of my friends sent their children away.
I would come home sweaty, exhausted, and undoubtedly drenched in COVID. My roommates and I developed an elaborate process to keep me separate. They would open the front door and step back, while I sprinted to the bathroom, where a clean towel and hamper waited. After a burning hot shower, I wiped every possible surface I could have touched. The skin on my hands cracked and bled from all the washing. My jaw line exploded in acne from where the N95 mask kept its life-saving seal. While doing chest compressions on a COVID patient I saw my hair fall forward into my face. I went home that night and cut it off in the mirror.
I began to wonder with a morbid fascination how or when the virus would affect me personally. There is no way I can live in the center of a global pandemic and not be affected. I was strangely relieved when the first of my friends caught it and thankfully recovered. Then it was two friends, then five. Who should I be telling I love them, before it’s too late?
While COVID mostly takes its gristly toll on adults, pediatric ICU is not spared. There are children with COVID every bit as sick as the adults. There are babies born to COVID positive mothers, separated for their own protection, fathers getting their first glimpses of their children over video. In the PICU, we allow one parent or guardian, who thereafter cannot leave the room except for a dedicated restroom. I watched a mother count her rosary while we worked on her daughter. I marveled at the cruelty of life.
In all this stress and suffering, there are glimmers of hope. Donated food appears constantly in our break room. My walk into work is lined with words of encouragement from elementary schools. And every time a patient’s breathing tube is removed and they breathe the free air again, the PA system plays “Here Comes the Sun” and across the endless hallways of the hospital, everyone stops to applaud.
I do not know if my life will ever return to normal. I do not know how this will change me, how it will change healthcare, how it will change society. All I know is that we must take care of each other. All I know is that we will not give up.
Stay safe and always remember, corona delenda est.