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“Don’t start a whistle chain unless there is an emergency.” The words rang in my ears, harmonizing with each blow of the bright orange whistle. I pursed my lips along its hard plastic edges, pale cheeks puffed releasing visible breath in the crisp New England air. Three long pulses, a rest measure, and repeat until I heard a response. After several minutes, 2 classmates arrived and escorted me down the mountain, through the thick brush, and back to base camp. I had lasted all of 6 hours on what was intended to be a 3-day solo camping trip.
It was my junior year of high school, and I was spending a semester at an environmentally focused boarding school on a farm in Vermont. Each student had the option of spending 3 days camping solo along a trail in New Hampshire’s White Mountains. Our campsites were a few hundred meters apart—just far enough not to see or hear each other during this time of reflection. Although the trip was technically optional, almost everyone did it. We would have no homework, no electronic devices, no contact with other humans—just time and space for deep personal reflection. It was intended to be a life-changing transcendental experience.
When I arrived at my camp site, I set up my shelter exactly how I had been trained, choosing 2 steady trees close enough together to hang my crinkly blue tarp and soggy camping hammock. I placed my sleeping bag in the hammock, placed myself in the sleeping bag, and lay watching raindrops make tiny dents on my new plastic roof. As I waited for a deep sense of meaning to diffuse from nature into my mind, a terrible churning arose in my stomach. My forehead dripped beads of sweat, my mouth felt dry, my limbs went numb. My heart raced as quickly as my thoughts—“I’m going to be sick. I’m going to die. No one will find me. A bear will eat my body. I need to get out.”
It was only after a few days at base camp with our instructors—neither of whom were exactly thrilled to share their long weekend with a chatty 16-year-old student—that I realized that the symptoms I’d experienced were those of a panic attack. I felt ashamed that I had started the whistle chain and that I had worried my peers. I was embarrassed that I couldn’t handle the wilderness and convinced that when my classmates heard about my panic attack, they would see me as weak. My body and mind had failed to adapt to a total isolation that I’d reassured myself I would never face again.
Nine years after my fateful trip to the White Mountains, I embarked on another solo journey—this time, one that I had not voluntarily joined. A few days after the University of Pennsylvania’s mid-spring break announcement that the remainder of our first year of medical school would be entirely virtual, I awoke in my childhood bedroom with a pounding headache. My limbs throbbed, and I imagined the bone marrow I’d learned about a few months earlier going into overdrive. My thermometer read 103 °F. It was early March, and there were only a handful of confirmed cases of coronavirus disease 2019 (COVID-19) in New York City. I told myself that COVID-19 was a zebra and that I must have influenza, took some acetaminophen, and asked my parents—out of an abundance of caution—to let me confine myself to my room. My parents left meals and disinfecting wipes outside of my door, joking that I was being a hypochondriac.
My mother asked me to get an influenza test, so we could stop the isolation shenanigans. Two days later, I donned a surgical mask and went to urgent care. The rapid influenza test was negative, and the physician insisted that I be tested for COVID-19. The call came midway through studying flashcards for our neurology block: I had tested positive for COVID-19. I traced my panic’s path from my amygdala, to my hypothalamus, down my spinal cord, and to my adrenals, trying desperately to detach from my fight or flight response. I knew just enough about microbiology and the global situation to know that I was powerless to do anything about this frightening infection.
My parents and I agreed that they should leave our contaminated apartment. That night, they packed their things, grabbed our 3 confused dogs, and promised we would stay in close contact. The fear that I had potentially exposed their older, weaker immune systems further fueled my general state of fatigue. I limited my campsite to the den and my bedroom, trying to contain the viral spillage with every one of my exhalations. On milder days, I kept our tenth story window overlooking the abandoned avenue open. With each breath, I tried to pull the chilly March air into the inferior lobes of my lungs, but tightness and congestion in my chest made it excruciatingly difficult. Although there were days when I could hardly sit up without panting, I wanted so badly to blow my orange whistle. I desperately wished someone would show up and reassure me that my parents and I would make it down the mountain.
When I told my mentor and classmates about my diagnosis, they expressed concern and curiosity. My mentor, a seasoned emergency medicine physician, took time to check in daily. My classmates applied the active listening skills, patience, and empathy we had practiced with our standardized patients, like master clinicians. When I decided to take a short leave of absence to focus on recovering, they offered to help me catch up on everything I had missed. They took it upon themselves to become my COVID companions, keeping me company while I was alone. Like the friends who had guided me down the mountain to base camp years ago, my medical school classmates became a powerful emotional compass, redirecting dark thoughts to a positive, hopeful place. My friends and mentor could not, with any certainty, promise me we all would be okay. But knowing they were looking out for my family and me made me feel better.
In total, I spent 21 days—the equivalent of 7 high school camping solos—by myself in the apartment without physically interacting with another living being. I kept track of the consecutive days that my parents reported no symptoms, and on day 14 I let out a tremendous exhale. My immune system was slowly winning, and the incubation period for my parents was over. It took another couple of weeks for the lingering fever to fully subside, my senses of taste and smell to return, and my energy level to approach my pre-COVID baseline. I am incredibly grateful for the outcome of my family’s COVID-19 scare and acutely aware of the privileges that enabled us to have them.
Not unlike a solo camping trip, the COVID-19 global pandemic has offered medical students an opportunity for the type of reflection to which isolation so readily lends itself. Since March, we have watched scrubs and white coats become synonymous with a hero’s cape. We have witnessed top medical officials speak truth to power and seen hospitals step up in times of great uncertainty and fear. We have observed inequality and injustice that we would do harm to ignore and will hopefully use the power that medical education affords to help spur long-overdue changes.
In April, when I stepped outside for the first time after 3 agonizing weeks, I couldn’t help but recall the 16-year-old girl stuck at base camp—the one who ached for the comfort and security of the great indoors. Back then, when students returned to the farm, we hugged each other as though it had been years. We ignored the stench of dirt and teenage musk that we had brought back from the woods, and felt drenched in appreciation of each other’s company. Leaving my sterile COVID-19 quarantine was nothing like that grimy reunion, but somehow—smiling under my mask from a safe 6 feet away at every person, dog, and pigeon—I could feel that self-same homecoming relief. It would be weeks before I was comfortable giving or receiving a human hug, but the feeling of fresh air proved to be the warmest embrace.
Corresponding Author: Charlotte Tisch, BA, Jordan Medical Education Center, 3400 Civic Center, Blvd Fifth Floor, Philadelphia, PA 19104 (firstname.lastname@example.org).
Published Online: September 21, 2020. doi:10.1001/jama.2020.19304
Conflict of Interest Disclosures: None reported.
Additional Contributions: I thank my parents for their love and support and Benjamin S. Abella, MD, MPhil, Department of Emergency Medicine, Penn Medicine, and Catherine Yang, BS, Perelman School of Medicine, for their encouragement and editorial input, neither of whom were compensated.
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Tisch CF. Camping Alone—Recovering From COVID-19. JAMA. 2020;324(14):1399–1400. doi:10.1001/jama.2020.19304
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