Friday, 3 April 2020

On the front lines of a pandemic, ‘I love you’ can mean ‘goodbye’

Separated from family and worried about patients and colleagues, an internist where the U.S. outbreak began counts losses and blessings.

“I love you,” I said to my wife. Then, quietly: “Goodbye.”

It was 6 a.m. and I was getting up for work. If I had said more, she would have had trouble falling back to sleep. She already had been woken numerous times in the night by our two boys, aged 4 and 13 months. Our loudly breathing 4-year-old was now curled on a pillow beside the bed.

“I love you,” she replied, starting to stir.

I felt an overwhelming desire to approach her, to feel the softness of her hair, the warmth of her touch, a simple kiss. With a hollow feeling, I turned and hurried away, not knowing when I would see her again.

Almost three weeks had passed since the Kirkland, Wash., hospital where I work diagnosed a pair of novel coronavirus cases and saw the earliest Covid-19 patients succumb to the ravages of the disease, becoming the epicenter of the national outbreak. That dark morning was the last time I saw my wife or children in person, as of this writing.

My wife and I had guessed — correctly, it turned out — that I had been exposed to patients infected with coronavirus before anybody knew the virus had landed here. While my colleagues and I scrambled to don and doff personal protective equipment that first day back on service, my wife scrambled to collect sippy cups, clothing for the family, activities and a travel crib, distracted by worries about whether I would become ill.

She and the children would bunk with a sibling’s family while I worked at the hospital and stayed in our house. The cousins could play together and she would have help; it would be safer than close quarters with grandparents.
Brian Rea

We both knew that I faced greater exposure with each passing day at work. It’s the reality of caring for hospitalized patients infected with a virus that spreads through air and can persist on surfaces for days. Each shift and patient increases the probability that another health care worker will become infected. Even more unnerving is the possibility of the virus hitching a ride home to our loved ones.

After the initial quarantine period passed and I remained healthy, I pleaded for my wife to come home with the children. By then, I had developed a ritual of changing out of scrubs at work and leaving them there, then removing my street clothes outside my house in the cold air and heading straight into a hot shower. In any other time, this would have seemed unnecessary, overwrought and compulsive. Now it was the norm.

To keep everyone safe, I proposed that, upon returning from work, I would avoid the children entirely and isolate myself in a spare room while my wife brought me food.

“Then I would have three boys to take care of, instead of two,” she said with a laugh. But she had another concern: She’s a dentist and didn’t want to put her patients at risk.

That worry became moot when her clinic canceled all appointments and remained open only for emergencies. Also, the virus was determined to be endemic, meaning there already had been community spread for weeks, so my family getting exposure from me seemed less of an issue. We made plans for them to return home, but then my 4-year-old developed a fever, cough and fatigue. Our normally energetic toddler spent two days in bed with shaking chills.

There still wasn’t adequate testing available to confirm whether it was the new coronavirus; it was safest to assume it was. Now the greater fear was me catching the virus from my family and having to miss two weeks of work when I was needed — a fear that was validated when I was called in to take over for a potentially sick colleague, causing me to work 10 out of 11 days.

For now, after each shift of 12 hours or longer, I have to be content with talking to my wife and children through a screen. I end each day waving at the laptop and saying, “I love you,” bidding another good night. The image quality is so good — their sweet faces so crisp and full of life — that it’s almost as though they are right here with me.

This real-time technology is at times a taunt of sorts, an agonizing reminder that our real-time technology wasn’t good enough to recognize a virus spreading unnoticed through so many communities. A taunt that despite our technological prowess, our testing capabilities are still woefully inadequate. Because we don’t have the technology, capacity or resources to test and to know, friends and families must stay apart.

In the time of the coronavirus, “I love you” is what we say before loneliness or loss, not before a hug or kiss.

“I love you,” says a female colleague of mine to her newborn baby after she tests positive for Covid-19 and has to self-isolate at home.

“I love you,” says an emergency room physician I know to his family before a breathing tube is inserted into his airway and his co-workers descend upon his body, working to save his life — the emotional struggle shattering the aura of invincibility we often feel as health care providers.

I love you,” says husband to wife, both of them ill from coronavirus, hospitalized in adjacent rooms. Their eyes meet as he is rolled away to the intensive care unit for mechanical ventilation as his condition rapidly worsens. It is possibly the last time they will see each other alive. Their exchange of “I love you” may be the last words they ever say to one another.

Behind the gowns, masks and goggles, there are no dry eyes among the nurses, respiratory therapists and doctors who have fought so hard to support him as they watch him get wheeled down the hall and out of sight.

An older woman, her lungs filling with pus and inflammation, struggles to say “I love you” to her grandsons via video chat; the virus is too contagious for an in-person goodbye. She’s breathing hard and visibly distressed. Both her daughter, who is a nurse, and I ask her to let us increase the dose of medications that will make her comfortable but sedated. She refuses for now as she wants to have a little more time with her grandsons to ask them about their homework.

I hear the patient’s daughter explaining to her boys that grandma is going to heaven and they won’t see her again. I walk closer to give her a hug, as I have done for many other dying patients, but I stop myself. This simple act of empathy as a health care provider, as a human being, carries too much risk of transmission.

As intensive care units here and around the country begin to run out of available beds, equipment and staff, these moments of people saying “I love you” when they mean “goodbye” will only become more commonplace.

And I am one of them.

“I love you,” I say to my own parents after telling them to stay at home as much as possible. I warn them they will not see their grandchildren or me for weeks, possibly months. My mother and father were fortunate to have survived the killing fields of Cambodia and to have emigrated to America. They were lucky to have found work and a home and a life here. But in their old age, with medical problems, I don’t trust their luck in a pandemic.

“Be careful,” my mother says. “I’m worried about you. You work too hard.”

She still remembers me as a frazzled medical student at the end of a 30-hour shift. Back then, she was a janitor at our county hospital, proudly watching her son make use of her sacrifices to work toward his dream of becoming a doctor. Now she is simply a mother worried about her child on the front lines of a war against an invisible enemy.

Saying goodbye as a way of showing love is also how we fight this virus. Right now, social distancing is the only way to protect loved ones who are most vulnerable. Video technology does help to bridge divides, as inadequate as it may feel.

It was bittersweet to watch my younger son’s first steps recently on an iPad. I was proud of him and glad to be able to witness him achieving this milestone, but I desperately had wanted to be the person he was walking toward.

Getting through the outbreak will not be easy and the worst is yet to come. None of us will emerge unscathed. But I believe that saying goodbye for now — and then keeping our distance — is our best hope of surviving and being able to return to a time when I can hold my wife and children close without a sense of fear.

When “I love you” means “hello” again.

(Source: NYT)

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