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A Piece of My Mind
September 4, 2020

Running on Fumes

Author Affiliations
  • 1Division of General Internal Medicine, University of Minnesota, Minneapolis
JAMA. 2020;324(12):1157-1158. doi:10.1001/jama.2020.17249

The drive to the hospital from the hotel that has become my home away from home is made on streets choked with traffic—a reminder that while the pandemic rages on within our walls, outside life goes on, seemingly unbothered.

I park the car and take a few moments to try to quiet my mind and prepare for the day ahead. My attempt is thwarted by questions that continue to swirl. The same questions every day. How many new coronavirus disease 2019 (COVID-19) patients will we admit today? How many patients who had been stable yesterday would now be in the intensive care unit? Or dead? Will this ever end?

With a sigh, I gather my gym bag and step out of the car. The windows of the skyway that connects the parking garage to the hospital are still filled with construction paper hearts crafted in the spring by area children, but their once-bright colors have faded and dulled by the bright sun of an interminably long summer. I used to study the words of encouragement scrawled on them and smile. Now, I barely register their presence. Yet another reminder that the work that was once applauded and labeled as heroic is now mundane. Expected. Unnoticed. The necessary cost of our premature return to normalcy.

I think back to March and the first time I crossed this skyway. March was a time of firsts and also a time of uncertainties and fears. Within days, the health care system transformed an old hospital (which had been repurposed as a long-term acute care facility) into the state’s first COVID-19–only cohort hospital. The day before I worked the opening shift, my wife and I used an online service to complete our first wills. Our neighbors witnessed as we signed them on the front porch. Later, I carried my bags out to the car, all of the things that I would need to live in a hotel for the next month. A cold, spring rain fell as my wife and I stood on our front porch and hugged. I could feel the slight bump that was just starting to signal that she was carrying our first child. We cried and hoped that it would not be the last time we ever touched.

But despite the fear and the lack of knowledge of what the weeks ahead would hold, there was also a sense of clarity and purpose. When the first patient with COVID-19 arrived, I had no doubt that I was where I was supposed to be. I was using my training and skills as a hospitalist to do my part in the struggle against a threat that we were all facing together.

And back then, it seemed like we were facing the threat of COVID-19 together. The news was full of images of people across the country coming together to celebrate frontline workers. Within days of opening, the skyway was lined with signs of encouragement. People lined up on the lawn outside of the hospital holding signs and singing songs of support. Restaurants and caterers donated more meals than we could possibly eat. Military jets flew overhead.

Although the obvious and outward displays of support at that time were greatly appreciated, even more gratifying was the sense that we were not alone. While health care workers were putting their lives at risk, the rest of the community were also making sacrifices. People were drastically changing their lives to flatten the curve and slow down the alarming spread of the virus. Minnesota had just initiated a shelter-in-place order, and it seemed that most people were taking it seriously. The shared sacrifice was apparent in the empty parking lots and closed restaurants that I passed on the way back and forth from the hotel to the hospital every day. At times, early in the morning, mine would be the only car on the road.

The empty roads were a sign of hope. It seemed that we, as a country and a community, might still be able come together and make huge sacrifices to address a crisis.

Now, 5 months later, the feelings of the spring are a distant memory. Hope gave way to frustration as the heartwarming images of mutual sacrifice were replaced by images of protests about the sanctity of dining out and getting haircuts. Political and economic pressures led many states to open without adequate testing or contact tracing in place. Wearing a mask, instead of being seen as a common-sense way to slow the spread of the virus, became the latest front in a never-ending culture war.

Now, even frustration has given way to a bone-deep sense of weariness and resignation. I am running on fumes.

Social media is a window into the world outside of my bubble of the hotel and the hospital. There, summer is in full swing and the pandemic that I grapple with daily is nothing but a distant memory. Gatherings and celebrations delayed in the spring now rage on without fear of consequence. The once-shuttered restaurants and bars that surround my hotel now thump and hum with business well into the night. Despite a statewide masking mandate, I still trudge up the stairs to my fourth-floor hotel room as people step off of the elevators and through the lobby barefaced and smiling.

Day after day, I armor myself in ill-fitting scrubs and an N95, walk past the faded remnants of support, and confront the ravages of a virus that is here to stay, no matter how hard we try to ignore it. I put my head down and labor through 11-hour shifts, bolstered only by the knowledge that for me there is an end or at least a reprieve.

My wife’s due date is fast approaching. So far, our caution (and the economic and social privilege that afford it) have kept the virus away from her and our unborn son. The last of my scheduled shifts will be over soon. After a period of quarantine in the hotel, I will return home. Our child will be born, and I will take advantage of a generous stretch of parental leave.

That is as far ahead as I allow myself to think. I am too exhausted by the events of the summer to think about what the fall or the winter will bring. So I don’t.

I tell myself that this is because the ups and downs of the past 5 months have made me more of a realist and that I have learned that things are changing so rapidly that planning too far into the future is rendered futile. But if I am truly honest with myself, I worry that the events of the summer have made me afraid to envision the new world into which my child will be born.

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

Corresponding Author: Bernard E. Trappey, MD, Center for the Art of Medicine, Division of General Internal Medicine, MMC 741, 420 Delaware St SE, University of Minnesota, Minneapolis, MN 55455 (trappey@umn.edu).

Published Online: September 4, 2020. doi:10.1001/jama.2020.17249

Conflict of Interest Disclosures: None reported.

Additional Contributions: I thank my wife for allowing me to tell this story.

3 Comments for this article
Reality Projected
Bipin Deshpande, MBBS, DVD, FAAD | Noble Hospital, Pune, INDIA
Sir, you have penned down an absolute real-life experience which is with each one of those who have worked tirelessly in this horrible COVID-19 pandemic.

This is a lifetime experience and all progress and technological advances achieved in the medical therapy and research has been challenged equally vehemently by the virus which has brought all developments to a standstill and has made us rethink and restart.

I appreciate your written account on your personal experience and I especially liked the end where you speak about your child about to be born in this hugely changing world in
a post-COVID era.
Me versus We
JB Bouvier, MD, MPH, MComH. | Research organisation, Humanitarian Health Worker
Dear "Confrere,"

Thanks for a reminder to do the things and be where we have to be as health workers. Thanks as well for illustrating that unless we think of the situation as We, collectively and together, we will not get away from this pandemic without damage that may well achieve what a competitive, individualist, no wrong profit economical model has started in term of an unequal society that can not lead to a bright future.

It will be our challenge collectively and by trying to leave no one behind in health care as in the broader society,
that this child of yours may at the end grow and be raised in a fairer and better society. Your writing makes me know that at least she/he will have the parents all our kids should wish for.

Duty and Obligation
Reed Allyn, MB, MSc. | University of British Columbia
Your sentiments have hit the emotional valley where the feelings of frustration, loneliness and a close sense of defeat reside as case numbers rise and deaths accumulate. It is the front line workers who face isolation in their care of COVID patients, those unfortunate patients and families unlucky enough to have contracted the disease, most who were trying to avoid it, and then regrettably, some who in the face of the science and warnings, chose to ignore the cautionary recommendations and regulation, supported by those who bravely interceded to research, understand and treat this disease. This in turn, has put those valiant healthcare workers at risk, imperiling their families and posing a threat to their colleagues. Sadly, we have lost some of our courageous healthcare professionals because of this. However, as a medical professional, I signed up for the unexpected, I trained to provide care to those diseased, and I am aware of the dangers that face healthcare workers everyday, including myself. But I certainly, like this author, didn't expect this. But as this essayist said in his/her eloquent writing, "I was using my training and skills as a hospitalist to do my part in the struggle against a threat that we were all facing together." The operative word "together" seems to have been lost somewhere in the past 5 months, and before this gets any better, the fundamental goal not as a country, state, province, race, religion, but as humankind, is to fight as "one", to help ourselves as "one". There's a long road ahead.