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A Piece of My Mind
July 16, 2020

Dressing Up

Author Affiliations
  • 1Einstein Medical Center, Philadelphia, Pennsylvania
JAMA. 2020;324(7):633-634. doi:10.1001/jama.2020.12779

When the dread starts to set in, when it gets hard to breathe, I adjust my N95 mask and remind myself of this: I am the granddaughter of a man who worked the depths of Idaho mines and knew a thing or two about personal protective equipment (PPE) hell.

My challenges as an emergency medicine physician during a modern pandemic marked by PPE shortages that require me to wear a single-use mask for an entire shift pale in comparison. Every piece of protective equipment my grandfather wore in the fiery bowels of the earth was a hard-won victory. He and his fellow miners had to fight tooth and nail to wear safety gloves, for example, because mine owners thought the time it took workers to remove and replace them slowed them down sufficiently that it cut too far into their profit margin. Lost fingers were just collateral damage in the wake of unmitigated greed.

Over the past few months, I have thought of my grandfather often. Every time I catch a glimpse of myself in full PPE in the azure glass of the negative pressure rooms housing the most critically ill patients with coronavirus disease 2019 (COVID-19), I can’t help but imagine myself entering a mine shaft. Here I am after decades of higher education, an opportunity that he would have envied, and I look much like a miner. Most of my face is covered, but if you watch my eyes closely, you can spot my smile at the thought.

You see, my grandfather is a bit of a legend in our family and among the community that still remembers him in northern Idaho. He not only fought for protective equipment for himself and his fellow miners, but he also organized unions at a time when doing so was considered anti-American and posed a risk to his family’s safety. He took it a step further and stared down the intimidation by inviting those who threatened him to his home, announcing his address on public radio. He ran for local office on a platform of equity and dignity for the common man and won. My enduring mental caricature of him is drawn with both fists in the air, tightly clenched.

Propelled very consciously by my need for resilience narrative in my time off, I recently watched the 2016 drama Chosen. The story centers on a Jewish attorney turned forced laborer in Hungary at the end of World War II. In keeping his deathbed promise to his beloved wife, and perhaps for no other reason, this man who once actively shunned the resistance became its leader. He went as far as dressing up as an SS officer to free opposition fighters, and in an emotional performance you are transported with him through the process of becoming the most reluctant of heroes, a title he most assuredly rejects even into old age. He acted out of necessity, perhaps, but more than anything out of obligation to a simple abiding love. He could not regard himself as a hero when action was his only choice.

To this, I can relate. The dominant rhetoric of this pandemic has been, quite positively, one of admiration and respect for frontline workers including doctors, and I am bolstered by the warmth and support I have received. Every act of kindness has nourished and renewed me, preparing me for another tiring round of gearing up to face an invisible enemy, redefining all the ways I care for patients, watching patients suffer while I often have little to offer, then systematically scrubbing down to keep this scourge out of my house and away from my family. I walk past signs on my way to the hospital proclaiming me and my colleagues heroic. “Heroes work here,” they say, punctuated with other inspirational messages and bright tokens of hope. Even my own neighbors have joined in, leaving me sweet messages of support in the form of posters and giant chalk drawings on the driveway to surprise me as I pull in, wilted and contaminated, after an exhausting shift. “Hometown hero,” they say. “Thank you for your service.”

Hero?

I wonder what my grandfather would think of me claiming this title. Would he find it as ill-fitting as the extra-large surgical gown and comically oversized face shield I now wear while intubating patients in respiratory distress? Worse, would it be a slap in the face of the real heroes like him, the war veterans, and those architects of our nation who very intentionally risked their lives in the service of that vision? Those who had the chutzpah to invite their enemies into their homes with a grin, middle fingers drawn.

These questions are all conjecture because my grandfather died before I was born, and my knowledge of him exists entirely in hand-me-down stories and the few pictures I have seen. One of the most poignant of these stories is one my father tells from his own boyhood, when he went to the mine to meet his father after work on a cold winter evening. He waited with great anticipation for several minutes as the elevators lifted the miners from the raw heat of the deep earth to the cool surface above. When the doors opened, my grandfather emerged, blackened from head to toe by and surrounded by a massive cloud of condensation. In front of the setting sun, it appeared as if he was on fire.

The jagged stone and precious metals my grandfather mined were used to build this country from the ground up, but so too was his ethos of collective action and responsibility. He broke knuckles fighting but was also known to quietly recite Shakespearean sonnets as he broke rock. As much as I admire him, I have struggled to know my grandfather, and grasping at his memory during this pandemic has led me inevitably down a path of comparative scrutiny on heroism. For sure, I stand in a mighty shadow.

When I am fully gowned up, I look startlingly unlike myself, unlike any human, really, to the point that I have had patients fearfully recoil during examinations. I have found it helpful to carry a picture of myself to show to patients, so they know who is caring for them. We both smile beneath our masks once we have been properly introduced, and I can continue my evaluation as they visibly relax. It feels like a remnant of life before the pandemic, an intentional reminder of the why behind the how we will get through this. A bit of light protest, even.

At the end of my shift, I slowly remove my mask, taking care not to contaminate myself. As I stand at the sink in front of the mirror, scrubbing my hands and humming a familiar melody to keep time, I study the deep indentations across my nose—my grandfather’s nose–left by the mask. “Is this the face of a hero?” I ask. The question makes me uncomfortable, and today I do not have an answer. I take a deep, unimpeded breath for the first time that day, my lungs clear, my heart steady.

Section Editor: Preeti Malani, MD, MSJ, Associate Editor.
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Article Information

Corresponding Author: Erica J. Harris, MD, Einstein Medical Center, 5501 Old York Rd, Korman Basement, Philadelphia, PA 19141 (harriser@einstein.edu).

Published Online: July 16, 2020. doi:10.1001/jama.2020.12779

Conflict of Interest Disclosures: None reported.

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    7 Comments for this article
    EXPAND ALL
    Dressing Up
    Robert Di Blasi, MD Assoc Prof Adjunct | Retired: USAR > 31yrs; TPMG Ob/Gyn > 20 yrs; Stanford Adjnct Faculty 18 yrs; CMO DoD x 15 yrs.
    Very moving, and a reminder that there is always someone who has hauled a tougher load. Our burden (I laugh at that word) to wear a mask is minuscule compared to what our grandparents suffered. Bringing that into perspective when I complain about my physical ailments (AFib>permanent, S/P Surgical Correction of ASD, Apnea etc) I remind myself of how lucky I am and I say "There is always someone worse off than I." 

    R J Di Blasi, MD
    CONFLICT OF INTEREST: None Reported
    Appreciate
    Catherine Moore, Certified Nurse Midwife | Brigham and Women's
    Well written. Really appreciate this. I have similarly questioned the "hero" moniker.
    CONFLICT OF INTEREST: None Reported
    Cost of Mine Safety
    James Nicholas, MD | Retired
    The cost of miners' safety gloves for your grandfather's mine owners reminds me of a story my grandfather told me in 1940 of an interchange in about 1910 between him and the superintendent of an iron ore mine in northern Minnesota. As night foreman of the mine, my grandfather asked for more timbers to shore up the walls and ceiling of the drift they were following, to make the mining safer. The response of the superintendent was 'Men are cheaper than timbers'.

    He and his son, my father, lived hard lives. Yet I have no memory of hearing
    them either complain about or brag about how hard it was. We owe our forebears much.
    CONFLICT OF INTEREST: None Reported
    READ MORE
    Beautiful Piece
    Amelia Silkworth, RN, BSN | Integrated Services of Kalamazoo (Community Mental Health)
    Lovely reflection. I printed copies (!) and shared with the front line staff. Thank you!
    CONFLICT OF INTEREST: None Reported
    Beautiful
    Justine Wu, MD, MPH | University of Michigan
    Thank you for an eloquent, moving, and deeply personal reflection about your role as a "hero" in this pandemic. As a primary care doctor- not doing inpatient care anymore- and primarily engaged in research behind a desk most days, I have cringed and felt discomfort when neighbors and friends thank me for my service. I shrug and thank them without feeling like it is deserved compared to the risks my patients take every day without the essential things they need to get by.

    Your grandfather was a hero and you honor him beautifully here. Thank you for sharing.
    CONFLICT OF INTEREST: None Reported
    "Un-American" PPE
    Anthony Glaser, MD, PhD | Paladina Health
    "He not only fought for protective equipment for himself and his fellow miners, but he also organized unions at a time when doing so was considered anti-American" . . . and now we have some people who consider not unions, but using protective equipment, or being told to use protective equipment, un-American.
    CONFLICT OF INTEREST: None Reported
    Resilience in Action - Beautiful!
    David Fessell, MD | University of Michigan
    Many thanks for sharing this beautiful piece. Reframing challenges through the lens of family--a grandfather who cleared a very difficult path for so many--nice! I feel your strength, and that of your grandfather. Your eloquent words let us know that you feel his strength each day, too. I'm imagining he's watching you with a smile, and lots and lots of pride. Thank you for all you are doing, and for sharing such an inspiring and connecting piece with us.
    CONFLICT OF INTEREST: I speak on the topic of resilience
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