Daily Ablutions

PATIENT, JULY 2014

I had to plan how to get out of bed and I resented it. Lying left side down, facing the only window to the outside, my thighs stuck together atop the plasticky mattress; I was trapped. Tangled in wires connected to the fetal monitors, I just wanted to get up and about. I was ready to get clean. Getting clean was the best part of my day, a forbidden pleasure. I didn’t ask if I was allowed to shower because I simply didn’t want to know the answer.

Right leg, left leg, brace the belly, swing up. Pant, pant, pant. I could feel my heart racing. Long, soothing breaths. I was ready. I pressed the button on the hand-held controller, taking care not to call the nurse, lowering the bed, disconnecting myself from my electronic guards and fumbled into my slippers. Shuffling 20 feet, I could see the shiny glory of the handicapped showerhead. Sitting on the shower chair, I stared at the clock just outside the bathroom door. 5:53 AM. I gave myself until 6:00 to remove my clothes, get rinsed, dressed, and horizontal again. I could rationalize a bedrest jailbreak that clocked in under 10 min.

When the tepid water hit my hair, I could almost ignore my breathlessness and tachycardia—my body felt free from its hospital gown shackles and double monitors. I imagined sheets of sweat and dirt falling off me, my guilt at being away from home and work rinsing down the drain in a potent mixture as I hastened to finish my routine before morning rounds. Waddling back to bed, I stopped to mark another day off on the wall calendar. 26 4/7 weeks. I was fresh and could face the day.

DOCTOR, APRIL 2020

In a dusty suitcase under my bed I find my scrubs, untouched for 15 years. Emblazoned with my hospital’s initials, their touch and feel stale, their smell not quite clean, I pull them on and tie my long hair back, adding a pair of funny socks showcasing dancing sushi to my ensemble. My kids giggle at my work pajamas, asking if they can come with me. No, babies, I soothe. There is nothing fun about venturing into the Respiratory Illness Clinic that afternoon on the first day it is open.

Right leg, left leg, walk to the outside barricade. Show my ID and health attestation. I don’t feel sick. I’m not sick. No cough here. I learn quickly how to “don and doff” my protective gear, leaving my N95 mask carving curves into my cheeks, marking me. Those first days are a blur of illness—sickness and exhaustion, a dizzying sequence of ambulances, questions about isolation and viral spread in a city bulging with essential workers, over-occupied apartments, and chronic disease. I barely stop to reflect on how I have adapted from my role as primary care listener and educator to an illness tracking triage artist and evaluator; somehow, our teams have coalesced to rapidly assess and disperse care.

When I stop to think, I dream about water—the first cool sip after I take off my mask, how it will feel to rinse away my day, watching the rhythmic swirl of the washing machine caress my aqua scrubs that night. At home later, I take off my clogs outside the door, sitting on a small chair just inside the kitchen, discarding and rolling my soiled clothes into a small ball. I creep naked through the house, stepping into the shower. Another ritual cleansing. Another minor jailbreak.

PATIENT, DECEMBER 2022

I’m drowning, he says. Me estoy ahogando, he repeats. He appears uncomfortable, rivulets of sweat dripping off his face; despite the fluid filling his lungs and legs, he is thirsty, itching to replace his sweat loss with gulps of water. He stops drinking to catch his breath. Pant pant pant. Can you give me something, he asks me in Spanish. I have to get back to work.

He had gained 30 pounds since his hospitalization 3 weeks prior. I’m taking the orange pill la chiquitita and the other one, he puffs. Huff huff huff. He hasn’t been able to get the machine to help him breathe at night. No me cubre—it isn’t covered, he tells me. I scroll through the electronic medical record as I watch his oxygen level hover in the 80 s; his safety net insurance will cover his sleep study but not the cost of the device to treat his sleep apnea.

I tell him he has to return to the hospital—there is too much water in your lungs. No, he replies. I need to work. At the local car shop, he toils 10 h a day washing and painting cars and sends most of his money back home, saving some for rent and food. And pills. Give me more of those water pills, he says. La chiquitita.

I can’t, it won’t help this time. I bargain with him—hospital? No. Home hospital? No. Repeat visit in 2 days with more medicine? OK.

We are both drowning.