You are waiting for the surge

The death toll from the march of Covid-19 through New York City soars past 10,000. You track the wave of patients requiring life support in Boston. Rhode Island — your state, your community, your hospital — is described as being caught between these two hot spots. Models predict you’ll be overrun with cases in a week or two. For now, you’re waiting for the surge.

During your last shift in the emergency department, almost everyone in your pod was infected with the virus that causes Covid-19. To try to function at your best, you improvise strategies for working safely with this deadly virus while keeping an arm’s length from the ever-present anxiety. One of them is adopting a second-person point of view. “You” provides six-foot separation from fragile emotional spaces. “You” gives you space to hear yourself while speaking directly to others; it’s a personal and a community voice.

Friends you haven’t heard from in years reach out. “How are you? “Do you have enough personal protective equipment?” You love the way terms like PPE and R0 float off their tongues. Teachers, artists, writers, academics, business owners, all sound more informed and reasoned than government “experts” about the pandemic response.

One of your favorite nurses asks, “How are you?” You smile. “I’m okay,” you answer, and make a lame joke like you were never okay in the first place. “How about you?” She nods and says, “People say they’re okay. But they’re not okay.”

Waiting for the surge you think about capacity. Not hospital capacity, like beds in the ward, beds in the ICU, ventilators, medications. You think about your capacity to cope with a stealth ninja that can kill with a sneeze you, your family and friends, and your community. It’s a different type of fear. It’s the terror that belongs to children who believe a monster is living in their closet and closing their eyes will make it appear. Only with Covid19, the monster is real and the parents in Washington D.C. who should be looking out for you have their eyes closed.

You pretend you aren’t bringing Covid-19 home with you from work. You remove your scrubs outside and pad downstairs to the washing machine in the basement. You’re sure the neighbors see more of you than anyone should. Waiting for the surge, you fear their young children will be permanently scarred by this hairy man hopping around the other side of the fence.

Waiting for the surge you pray for your family because they’ve been at home, strict practitioners of social distancing, and if they become infected it’s all on you. You wish you possessed faith in a higher power. Spiritual comfort would be a nice addition to your personal protective equipment. What if there happens to be a faith emergency department, a spiritual space open 24/7 that anyone can call on in a pinch? The waiting room is probably packed, you think. And there’s a loud knucklehead demanding to be seen now. And it’s you!

Waiting for the surge your family discussions turn from summer plans to advanced directives. You notice your son, an only child who is supposed to head off to college in the fall, now complaining less about the changing face of his freshman year when the conversation turns to family finances and all that he will need to do should his father become ill.

More Covid-19 patients fill your hospital. Waves of them from homeless shelters and nursing homes and large families who live closely together. The death toll rises. Thinking about what’s going on with patients is hard while you also try to concentrate on your every gesture. What did you touch? Did you wash your hands? Don’t scratch your nose. Don’t play with your goggles even if they dig into your face and rub that tender spot above your ears.

Waiting for surge you learn that breathing for eight hours — roughly 9,000 breaths — against the tight seal of an N95 mask is serious work. Your mouth turns desert dry. Your nostrils become raw. You become dehydrated quickly but, because leaving the unit to pee requires doffing your protective gear and then putting on fresh equipment, drinking fluids is something you do sparingly.

Waiting for the surge you can’t sleep. Mindfulness fails. Any headspace you create fills with thoughts about all the deaths and about your family. You can’t stop thinking about friends and colleagues in Boston and New York City, where you used to work. Everyone fighting the surge or waiting for it to come. Pressure builds behind your eyes. Your nose turns stuffy. Perhaps that’s your version of a silent prayer.

Waiting for the surge you want to scream into the night because leaders weren’t waiting for the surge, they were ignoring it. Because selfish opportunists have turned N95 masks that once sold for a buck apiece into a commodity that now sells for nearly ten dollars.

You wait for the surge by not waiting. Instead, you do. Your emergency department and the hospital has been preparing for a month. Doctors and nurses and hospital staff are coming together.

You wait for the surge by opening your eyes. Spring is pushing flowers from the ground. And despite repeated failures by government, there’s compassion blooming all around, people are donating personal protective equipment, sewing masks at home, keeping each other fed, and soliciting gently used iPads so patients in hospitals can stay connected to their families. The only way out of this is through a shared purpose and a collective voice.

You wait for the surge through a mutual point of view. “You” doesn’t let us forget that individual exposure risk is tied to societal behavior, that we’re responsible and accountable for each other. “You” can be an insistent and urgent voice.

There’s no more waiting. The surge is now upon you.

As you walk home after a shift, a neighbor driving by stops and rolls down his car window. “You’re my hero,” he says. “We wish you the best.” You stand in the road awkwardly, chilled from the waning sunlight and the gusting winds. You’re embarrassed. You’re not a hero — you’re an ER doc. Besides, waiting for the surge has produced so many heroes in hospitals and in communities.

But the feeling behind his words break through the distance. I graciously accept his good wishes and stuff them deep into my pockets, thank him, and tell him to stay safe.

Jay Baruch, M.D., is associate professor of emergency medicine and director of the medical humanities and bioethics scholarly concentration at the Alpert Medical School of Brown University.