Six Feet Apart, yet Closer than Ever

As a third-year pulmonary and critical care fellow at a large academic center in New York City during the coronavirus disease (COVID-19) pandemic, I felt confident when I volunteered to help at one of the many overwhelmed community hospitals across the city. I changed into scrubs and donned a face mask as I entered the intensive care unit (ICU), prepared to confront the challenges that awaited me. I was ready.

Twelve hours later, I cried in the Uber car on my way home.

Earlier in the day, I had been called by a nurse to assess a middle-aged woman who was struggling to breathe despite the maximal amount of supplemental oxygen provided. Like so many others, she had severe COVID-19 pneumonia and blossoming opacities on a chest radiograph, heralding impending respiratory failure.

“Hello, Ms. Smith,” I said, gently placing a gloved hand on her arm. I explained the need for intubation and placement on a ventilator to assist her failing lungs. (The patient’s name and some identifying details have been modified to protect her privacy.) Though she was visibly frightened, she agreed. Because the hospital could not allow visitors, we video called her daughter, allowing only a short, terse, and emotional exchange.

I called my attending physician to alert him to the need for another intubation—the eighth of the day as of only 3:00 p.m. I sighed as I added Ms. Smith to a growing backlog of critically ill patients without a bed in our overflowing ICU. Intubated patients were filling beds on the regular ward, and our small team struggled to stay afloat while juggling resources that were becoming scarce. It seemed impossible not to feel helpless and overwhelmed. Before I could collect my thoughts, an overhead announcement blasted out another call for a rapid response, and I rushed to the next disaster.

After my shift ended, I diligently shuttered myself within the confines of my home until the next day, when the battle began anew. Emotions ran high, from frustration at our inability to do more for the surge of ailing patients to anxiety about falling ill myself and an uncertain future. Compounding these concerns was a sense of isolation, as I sat alone in my apartment, without the warm company of family, friends, and colleagues. In those first few days in the frenetic scramble against the virus, I couldn’t help but feel a crushing sense of despair and loneliness.

Yet, as the days to weeks passed and social distancing became the new norm, I adopted different ways of connecting with those around me. I formed a group chat with other fellows in my program that we used to text each other daily, comparing notes and sharing stories. We checked on each other and cried with each other on the phone and through FaceTime (Apple Inc.). Their own harrowing experiences mirrored mine, and we were brought closer together by shared grief, frustration, and helplessness against what felt like an insurmountable foe when confronted alone. Indeed, there was a heavy toll that came from working endless shifts, witnessing patients and colleagues alike succumbing to the virus, but I began to realize that this was a burden carried on the shoulders of many. We reminded one another that, though we were physically apart, we were fighting this battle together, now more than ever, as a team.

And it didn’t take long before our team began to expand.

One Sunday, as we prepared for rounds in the ICU, a team member wrote down a patient’s morning electrolytes on the glass door to the room, allowing easy visualization of key pieces of information. I had never met him before, because he was a neurosurgeon who had recently joined us. Though he missed the operating room and critical care medicine was not his specialty, he was eager to help where he could. He learned from us, laughing as he returned to his medical school days, and he shared the workload, updating families, recording blood work, and checking on recommendations from consultants.

Later in the day, I met nurses, respiratory therapists, operating room technicians, residents, and fellows from other specialties who had come to join the fight against COVID-19. Some who joined the fight had come out of retirement, whereas others came from across the country. As pulmonary and critical care fellows, we organized and participated in training sessions on prone positioning, airway management, and cardiopulmonary resuscitation for these healthcare providers. We also led a crash course on the fundamentals of ventilator management, acute respiratory distress syndrome, and septic shock. Despite this time of dread and anxiety, I couldn’t help but smile when I saw the same surgical attending physician participate in our teaching session on four separate occasions, each time listening diligently and taking notes to ensure he had not missed any detail.

Outside the hospital, we may have confined ourselves to our homes, but we still managed to come together, albeit through remote means. Our divisional social worker kept in touch with us regularly through e-mail and by phone, offering practical tips for self-care and hosting weekly wellness sessions over Zoom (Zoom Video Communications, Inc.). Our attending physicians strove to provide continuity in our education as fellows, moving to daily video conferencing for the discussion of recent COVID-19 literature and weekly review of educational cases.

There also came an explosion of scientific and scholarly pursuits, ranging from analyzing epidemiologic trends in patient characteristics and outcomes to clinical trials on therapeutics. Clinician scientists also joined the team, halting their previous research efforts to focus on better understanding the virus. Innovations to split one ventilator between two patients and transform sleep apnea machines into ventilators surfaced through the conjoined efforts of many experts across a wide spectrum of disciplines. It was truly a mark of our resilience that, in the face of such calamity, we could band together as a community, supporting each other and providing unfaltering clinical care while spearheading scientific studies so that we may one day overcome this pandemic. I thought back to Ms. Smith and the countless others whose lives had been ravaged by the virus, and I reminded myself that the challenges I faced and will continue to face will be confronted by not only myself but also a battalion of healthcare workers.

Despite our adherence to the social distancing mandate, there has been a palpable sense of community and closeness. Every day at 7:00 p.m. since the beginning of this pandemic, the unsettlingly quiet streets of a once-bustling and sleepless mecca of culture, life, and economy have once again come alive, filled with the clapping, cheers, and roars of the many New Yorkers who are also fighting with us.

It is a powerful daily reminder that I am not—that we are not—alone.