Am I Helpless?

I wake up to a cacophony of beeps and rings. There are several notifications on my phone—all messages from my loved ones in India, whom I had left when I sought training in the United States. I have thought of them often during my journey as an immigrant physician. They have been my pillars of support, the constants to whom I have anchored myself while toiling as a resident, uncertain about my future exams, applications, and prospects. But now they are frightened and anxious as India plunges into the throes of the coronavirus disease-2019 (COVID-19) pandemic. Now they are the uncertain ones, and I yearn to be the pillar that they have been for me. But separated by a world between us, I feel helpless.

The COVID-19 pandemic began more than a year ago. We have seen 2 surges in New York. The first surge (March and April 2020) was marred with fear, uncertainty, and supply shortages, including a lack of personal protective equipment. Fortunately, administrations were mobilized to anticipate and address the need for invaluable resources like hospital beds, ventilators, and health care workers (1). Like many colleagues, I had the opportunity to serve on the front lines, caring for patients with COVID-19. Worried about my health, my loved ones from India called me daily. They prayed for my safety and would console me as I experienced deep sadness for every patient lost.

Shortly after Thanksgiving, the second surge (November 2020 through March 2021) returned in full force. The situation was grim, with hospitals well over capacity. While this second wave grew to alarming heights in the United States, the situation in India was comparatively quiet amid a strict nationwide lockdown. Wearied by months of social isolation, economic downturn, and political backlash, India began a stepwise process to reopen in June 2020, emphasizing economic rehabilitation. Between a gradual return to social norms and the vaccination rollout program, there was a guarded sense of jubilation. But this was the calm before the storm.

March 2021 heralded a slow increase in the number of cases in India, attributed both to a new virulent strain and relaxed social distancing measures. In a mere couple of weeks, the hospitals were overrun by sickness. The pandemic spread unmitigated at a ferocious pace. The health care system has been overwhelmed and, in many places, incapacitated by shortages of essential supplies like personal protective equipment, hospital beds, supplemental oxygen, and ventilators.

News outlets were saturated with tragic stories from India. Meanwhile, my phone was saturated with messages from the loved ones whom I had left behind. With growing trepidation, I read each message and called each relative—those pillars to whom I had anchored myself. The situation was dire, and the feelings were of hopelessness. Gratefully, none of them were critically ill—yet. While the news reported overwhelmed burial grounds, my relatives shared their anguish over the deaths of their lifelong friends. The reality of their situation and the sadness in their voices were gut-wrenching.

All I could do was listen to their stories and share in their pain. Their sadness, stress, and fear were palpable. They shared their uncertainties with me. The local hospital ran out of beds; where would they go if they needed help? Oxygen was in short supply; what would happen if they became hypoxic? Children were worried for their parents and vice versa. I did what I could to listen, comfort, and offer much-needed emotional and spiritual support. We kept coming back to the notion of karma and stories from Hindu mythology, emphasizing the age-old lessons to do our best and leave the rest to God.

I ended each conversation with an increasing sense of unease over my role (Figure 1). In the United States, I did my best to provide world-class care to my patients, armed with every resource available. I came here in search of the best training possible, leaving my family behind. Now, I was second-guessing myself. Why was I here? Was I selfish for not being back home? Like many immigrant physicians, these questions still make me restless at night. The guilt can be paralyzing. I do my best to provide comfort and advice. But mostly, I feel helpless.

Figure 1.

Emotional State of Indian Immigrant Physician

Created by and reproduced with permission from Shirlene Obuobi, MD.

As a doctor, many of my relatives asked me for medical advice. I reviewed scores of images about their health information. Many were taking multiple antibiotics, proton pump inhibitors, steroids, multivitamins, paracetamol, and so on. In addition, everyone was drinking various herbal teas and other “natural remedies.” With the ongoing surge, there were dire shortages of hospital beds and credentialed health care workers. Many were relegated to seeking help from untrained quacks (2). This was all exacerbated by rampant misinformation disseminated via print, visual, and social media about the benefits of unstudied natural remedies. Misinformation about vaccines (ie, vaccines being used by the government for population control and vaccines causing COVID-19 and death) has been particularly troubling and has contributed to vaccine hesitancy.

As they asked me for medical advice, my sense of helplessness grew. They often had incomplete and outdated information because of visitor restrictions and health care illiteracy. Furthermore, my advice as an U.S. trainee in a resource-abundant setting was mismatched for their context, with worsening shortages of even the most basic supplies. Offering medical advice is likely not just ineffective but may be potentially harmful. But I realized that I am not helpless. With each conversation, I realized that many of these questions are coming from a sense of desperation and uncertainty. I could help them by listening, counseling, and dispelling misinformation.

Over the next week, 7 family members became critically ill. Four were lucky to find a hospital bed; 3 of them got better, and one could not make it. Unfortunately, of the 3 who were unable to get a hospital bed, 2 died at home. Tragically, too many of my immigrant colleagues share similar stories. The stories of resource shortages, overflowing hospitals, and overwhelmed crematoriums and burial grounds in the news are painfully real for us. Our relatives are the ones being turned away from hospitals in their times of need. Every day has been a new challenge, and we fear news of the demise of another loved one, those pillars we looked up to for support.

Every Indian immigrant physician has similar stories and has felt these emotions. We support each other in our workrooms and on social media. We are torn by the juxtaposition of what is happening back at home against the world-class care that we are privileged to provide here. We join our colleagues in celebrating the scores of vaccinations being implemented in the United States but remain distraught by the scores of Indians succumbing to the pandemic (3). We are living amidst these contrasting realities. But we are not entirely helpless. Our relatives back home are now uncertain about their prospects, and we must support them with our listening ears, emotional support, and education to combat misinformation. More than that, we must be the voices to raise awareness about these tragedies by sharing our relatives’ stories and advocating for humanitarian support. We cannot see or hold our loved ones back home. But we will stand together, tall and strong for them in their moments of need. We are now their pillars.

Funding Support and Author Disclosures

The author has reported that they have no relationships relevant to the contents of this paper to disclose.